I 


TREATISE 


ON  THE 


ECLECTIC  SOUTHERN  PRACTICE 


OF 


MEDICINE. 


BY 

J.  CAM.  MASSIE,  M.  D. 


"He  who  does  his  best,  however  little,  is  always  to  be  distinguished  from  him 
who  does  nothing." — Dr.  Johnson. 


PHILADELPHIA: 

THOMAS,  COWPERTHWAIT  &  CO.,  NO.  253  MARKET  ST. 
NEW  ORLEANS— J.  B.  STEEL. 
ST.  LOUIS— A.  H.  SHULTZ  &  CO. 

1854. 


t 


Entered  according  to  Act  of  Congress,  in  the  year  1853,  by 
J.  CAM.   MASS  IE,   M.  D . , 
in  the  Clerk's  Office  of  the  District  Court  of  the  Eastern  District  of  Pennsylvania. 


CRISSY  &  MARKLET,  PRINTERS, 
Goldsmiths  Hall,  Library  Street,  Philadelphia. 


TO 


THE  MEDICAL  GENTLEMEN. 


■\YHOS^  PARTIALITY  INDUCED  THEM  TO 

SOLICIT  THE  WRITER  TO  PREPARE  THIS  WORK, 

IT  IS  INSCRIBED,  WITH  SENTIMENTS  OF  ESTEEM, 

BT  THEIR  FHIEXD  AND  OBEDIENT  SERVANT, 


J.  C.  MASSIE,  M.  D. 


Digitized  by  the  Internet  Archive 
in  2014 


https://archive.org/details/treatiseoneclect01mass 


s 


Chappell  Hill,  September  11,  1852. 

Dr.  J.  C.  Massie  : 

Dear  Sir — The  profession  is  much  in  need  of  a  work  on  the 
Theory  and  Practice  of  Medicine  ;  and  such  a  work  written  by  one  of 
their  own  number,  and  presenting  the  various  modifications  which  dis- 
eases assume  in  Texas,  has  long  been  needed.  You  being  an  eclectic 
in  its  broadest  sense,  and  enjoying  an  enviable  reputation,  both  as  a 
Physician  and  Medical  Correspondent,  and  from  our  knowledge  of  you, 
personally,  we  are  confident  there  is  none  better  qualified  by  enlarged 
reading  and  ample  experience  to  supply  this  desideratum  than  yourself. 

We,  therefore,  hope  that  you  will  not  fail  to  present  to  the  public, 
at  as  early  a  period  as  possible,  the  result  of  your  reflections  and 
experience  in  this  interesting  department  of  Medical  Literature. 

Entertaining  the  hope  that  you  will  oblige  your  friends  by  embark- 
ing in  this  undertaking,  we  have  the  honor  to  be,  with  high  appre- 
ciation, 

Very  truly  your  friends, 

WM.  S.  ROGERS,  M.  D.,  Chappell  Hill, 

W.  LEIGH  TUNSTALL,  M.  D.,  Do. 

J.  W.  LOCKHART,  M.  D.,  Do. 

R.  J.  SWEARENGIN,  M.  D.,  Do. 

J.  RANDOLPH  WEIR,  M.  D.,  Do. 

J.  BLACK,  M.  D.,  Fort  Bend, 

J.  A.  WOOLFOLK,  M.  D.,  Tesana, 

J.  L.  IRION,  M.  D.,  Montgomery, 

D.  C.  DICKSON,  M.  D.,  Grimes  county, 

F.  T.  WELLS,  M.  D.,  Texana, 

WM.  A.  MINNOCK,  M.  D.,  Spring  Creek. 

LOUIS  A.  BRYAN,  M.  D.,  Houston, 

SIM.  HOPKINS,  M.  D.,  Leon  county, 

W.  C.  McGOWN,  M.  D.»  Frelsburg. 


c 


MEDICAL  CORRESPONDENCE. 


R,EPLY. 

HOUSTON,  Texas,  November  17,  1852. 

GENTLEMEN  : — In  acknowledging  the  receipt  of  your  letter  of  the 
lltl^of  September,  I  cannot  refrain  from  expressing  my  grateful 
nov  lodgments  of  the  complimentary  manner  in  which  your  par- 
tiality has  induced  you  to  speak  of  me  :  such  kindness  has  more  than 
its  ordinary  value,  when  coming  from  gentlemen  occupying  the  dis- 
tinguished position  in  society  as  well  as  in  our  common  profession, 
which  universal  assent  accords  to  you. 

There  are  few  among  us  who  would  not  entirely  agree  with  you  in 
the  great  utility  of  such  a  work  as  you  speak  of — a  work  on  the  Theory 
and  Practice  of  Medicine,  particularly  on  the  practice  as  specially 
adapted  to  the  peculiar  manner  in  which  diseases  manifest  themselves 
in  Texas,  for  the  existence  of  such  peculiarities  has  often  been  observed 
by  our  most  intelligent  physicians :  indeed,  I  may  say,  all  medical 
men  have  more  or  less  felt  the  necessities  of  such  a  treatise.  Situated 
as  we  are,  scattered  over  a  wide  spreading  country,  without  the  oppor- 
tunities of  association,  which  in  the  great  metropolitan  cities  give  so 
much  impulse  to  the  progress  of  every  science,  and  of  which  so  many 
glorious  institutions  attest  the  readiness  of  mankind  to  avail  them- 
selves, our  experience  becomes  isolated  and  individual,  and  we  live, 
learn  and  die,  without  contributing  the  results  which  our  acquisitions 
of  knowledge  have  produced,  or  warning  against  the  errors  which  we 
have  committed,  either  to  our  cotemporaries  or  those  who  come  after 
us.  Such  reflections  have  often  been  present  to  my  mind,  and  it  has 
always  been  with  me  an  object  of  desire  and  ambition  to  produce  a 
work  of  the  kind,  which  might  be  worthy  of  attention,  and  procure 
for  me,  if  not  the  recompense  of  applause,  at  least  the  consciousness  of 
having  endeavored  to  be  useful.  Our  profession  is  eminently  philan- 
thropic, and  to  all  worthy  members,  the  pecuniary  gratifications  we  are 
compelled  by  circumstances  to  receive,  and  even  the  rewards  of  well- 
earned  reputation  itself,  however  dear  it  must  be  to  every  sensitive 
mind,  are  both  secondary  to  the  happiness  we  derive  from  relieving 
suffering  humanity — such,  also,  should  be  the  sentiment  of  the  medical 


MEDICAL  CORRESPONDENCE. 


7 


writer.  I  had  even  gone  so  far  as  to  prepare  many  notes  upon  this 
subject,  and  had  accumulated  a  mass  of  facts,  derived  from  the  expe- 
rience of  others  as  well  as  my  own  most  careful  observation,  and, 
while  I  admit  that  this  intention  has  never  been  entirely  dismissed 
from  my  mind,  yet  the  cares  of  a  most  laborious  practice,  and  an  unaf- 
fected diffidence  of  my  ability  to  ensure  or  merit  success,  together  with 
a  fear  of  being  deemed  presumptuous  and  the  dread  of  failure,  have 
hitherto  deterred  me.  Encouraged  by  your  most  flattering  invitation  to 
undertake  what  so  many  of  you  are  equal,  if  not  more  competent  to 
perform,  1  will  venture  on  the  task ;  but  in  doing  so,  I  shall  not  rely 
alone  on  my  own  feeble  and  unsupported  abilities,  which  you  are 
pleased  so  much  too  highly  to  estimate,  but  shall  expect  to  receive 
from  each  of  you,  and  the  members  of  the  profession  generally,  a  cor- 
dial and  welcome  assistance. — We  have  a  common,  not  an  individual 
aim  to  accomplish. 

Some  observations  upon  the  manner  in  which,  in  my  opinion,  such 
a  work  ought  to  be  written,  may  not  be  here  inappropriate,  and  I  rely 
upon  your  indulgence  if  I  detain  you  with  a  few. — Works  styling 
themselves  of  "  Domestic  Medicine/'  have  deluged  the  country,  not 
only  to  the  prejudice  of  the  profession,  (which  is  in  this  respect  of  minor 
importance)  but  to  the  abuse  of  the  public,  and  the  great  sacrifice  of 
human  life.  Any  work  upon  medicine  which  pretends  to  dispense 
with  the  necessity  of  calling  professional  aid  in  all  cases  of  importance, 
is  in  general  a  wicked  imposture,  or  where  presented  in  good  faith,  a 
preposterous  idea.  The  great  desideratum  is,  a  treatise,  not  so  strictly 
technical  as  to  be  confined  in  usefulness  to  the  profession  alone,  but 
while  purely  scientific,  at  the  same  time  composed  in  that  simple  and 
popular  style  which  renders  subjects,  however  abstruse,  comprehensi- 
ble and  even  entertaining  to  the  general  reader.  I  do  not  mean  that 
it  should  not  possess  the  necessary  formulas  of  practice,  but  these 
should  be  so  blended  with  theory  as  to  render  the  reason  and  the  phi- 
losophy of  the  employment  of  the  remedies  indicated  clear  and  intelli- 
gible— in  short,  a  book,  which  would  be  a  desirable  addition  to  the 
library  of  the  practitioner,  and  moreover  a  valuable  aid  to  every  father 
of  a  family,  enabling  him  to  act  with  understanding  in  cases  of  em- 
ergency, to  judge  of  the  qualifications  of  the  physician  he  might  be 
compelled  to  employ,  and  guard  him  against  the  imposition  of  those 
ignorant  empirics,  the  great  number  of  whom  I  am  surely  not  severe 


8 


MEDICAL  CORRESPONDENCE. 


in  regarding  as  the  curse  of  this  country;  such  a  work,  as  you  justly 
intimate,  must  be  thoroughly  eclectic,  and  not  (as  we  have  seen  so 
many  of  late)  devoted  to  the  absurd  and  ephemeral  theories  of  the  day, 
which  seem  to  succeed  one  another  as  season  succeeds  season,  and  how- 
ever contradictory  or  opposite  they  may  be,  can  yet  each  become  the 
fashion  of  the  hour.  These  I  shall  leave  to  those  who  delight  in  them. 
Attention  should  be  called  to  whatever  are  already  acknowledged  facts, 
and  for  practice,  these  facts  should  be  appropriately  classified  and 
distinctly  presented  to  the  mind.  Neither  novel  views  nor  fanciful 
theories  ought,  in  such  a  treatise,  to  be  advanced  or  advocated.  How 
far  you  may  approve  such  a  plan,  or  I  may  be  able  to  carry  it  out 
with  success,  remains  to  be  proved.  My  main  reliance  is  on  your 
generous  aid.  After  the  accomplishment  of  my  task,  should  I,  indeed, 
be  permitted  to  fulfill  it,  I  shall  be  more  than  rewarded,  if  I  can  say 
in  the  words  of  Sir  William  Temple — "  If  I  have  not  been  able  to 
inform  men  more  than  they  knew,  I  may  yet  have  given  them  occasion 
to  consider  more  than  they  do." 

Renewing  my  thanks  for  the  honor  you  have  conferred  upon  me, 
with  my  best  wishes  for  your  personal  welfare,  I  remain,  respectfully, 
your  obedient  servant, 

J.  C.  MASSIE,  M.  D. 


To  Messrs.  W.  S.  ROGERS, 

W.  LEIGH  TUNSTJ 

J.  W.  LOCKHART, 

J.  BLACK, 

J.  A.  WOOLFOLK, 

J.  L.  IRION, 

D.  C.  DICKSON, 


R.  J.  SWEARENGIN, 
J.  RANDOLPH  WEIR, 
F.  T.  WELLS, 
WM.  A.  MINNOCK, 
LOUIS  A.  BRYAN, 
SIM.  HOPKINS, 
W.  C.  McGOWN. 


PKEF ACE 


It  would  be  a  grateful  task  to  us,  by  way  of  introduction  to 
the  following  essay,  to  give  our  readers  a  rapid  sketch  of  the 
history  of  the  practice  of  medicine.  "We  should  delight  to 
journey  with  them  through  the  labyrinths  of  times  long  gone 
by,  and  hand  in  hand  to  trace  with  them  the  paths  of  the 
science  of  medicine  from  its  first  rude  beginning  when  supersti- 
tion was  its  principal  means  of  action  and  a  few  simple  herbs 
formed  its  whole  body  of  agents,  through  its  various  advances, 
retrogressing  and  occasional  declines,  until  it  at  length  assumed 
the  proportions  of  a  correct  and  continually  progressive  science, 
and  became  exclusively  practiced  by  a  particular  class  of  per- 
sons, as  a  distinct  art.  But  time  and  space  and  the  practical 
nature  we  have  endeavoured  to  give  to  our  work,  preclude  this 
attempt,  which  after  all  might  prove  more  curious  than  useful, 
and  we  shall  confine  ourselves  to  a  few  remarks  on  the  influence 
which  the  different  theories  that  have  from  time  to  time  prevailed, 
have  exerted  over  the  practice  of  medicine. 

Let  us  commence  by  examining  the  notions  of  the  Egyptian 
physicians,  the  earliest  of  whom  we  have  any  record.  How 


10 


PREFACE. 


would  their  theories  sound  to  us  ?  They  taught  that  there  were 
thirty-six  demons,  each  of  which  was  supposed  to  have  the  power 
of  exercising  an  influence  over  a  particular  part  of  the  body; 
and  the  physician  called  to  relieve  the  sick  invoked  the  demon, 
according  to  the  part  affected. 

The  Greeks  surpassed  them  not.  On  the  contrary,  borrowing 
from  them,  they  deified  the  first  physician  who  appeared  amongst 
them,  made  the  healing  art  hereditary  in  his  family,  and  for  the 
cure  of  all  diseases  relied  upon  incantations. 

Even  Hippocrates,  one  of  those  sublime  geniuses  whom  Pro- 
vidence from  time  to  time  raises  up  and  who  so  far  surpass  their 
cotemporaries  as  to  create  and  mark  an  era  in  any  science  they 
touch,  who  won  from  his  own  age  and  maintains  to  the  present 
day  the  title  of  Father  of  Medicine — even  he  was  not  free  from 
this  all  pervading  influence  of  theory. 

Imbued  with  the  principles  of  the  Pythagorean  philosophy — 
a  philosophy  which  teaches  that  fire  is  the  first  origin  of  all 
matt cr,  producing  by  its  agitations  and  peculiar  combinations 
the  four  elements  :  fire,  earth,  air  and  water.  He  considered  that 
the  human  body  itself  was  composed  of  these  four  elements, 
and  taught  that  the  fluids  are  the  primary  seat  of  all  diseases, 
an  opinion  which  still  prevails  in  the  school  of  the  Humoralists. 

But  he  enjoyed  the  peculiar  advantage  which  so  few  physicians 
possess  of  not  allowing  himself  in  practice  to  be  carried  away 
by  his  own  favourite  theory.  Relying,  perhaps,*  too  much  on 
the  curative  powers  of  nature,  which  he  called  $vyls,  he  delayed 
applying  his  remedies  until  the  fatal  crisis,  when  neither  science 
nor  art  could  avail.  And  some  of  his  more  sanguine  followers 
in  this  particular  gave  rise  to  that  system  of  treatment  which 
we  may  be  permitted  to  term  the  expectant  school. 


PREFACE. 


11 


From  the  time  of  Hippocrates  to  the  days  of  Galen,  various 
schools  and  theories  had  prevailed,  all  of  which  we  do  not  deem 
it  necessary  to  notice.  The  Methodists,  or  rather  the  Methodics, 
which  Litter  term  we  prefer  as  distinguishing  them  from  the 
religious  sect  of  the  former  name,  far  from  relying  too  much,  as 
did  Hippocrates,  upon  the  curative  powers  of  nature,  rushed 
into  the  other  extreme,  and  taught  that  the  efforts  of  nature  in 
disease  should  be  positively  counteracted.  And  to  this  school 
we  are,  perhaps,  indebted  for  the  still  prevailing  maxim  "  con- 
traria  contrariis  curantur" 

Two  schools  of  diametrically  opposite  principles  at  the  same 
time  divided  the  medical  world — the  Dogmatists  and  the  Em- 
pyrics.  The  Dogmatists  taught  that  in  the  treatment  of  a 
disease  we  must  first  study  its  nature  and  causes,  and  apply 
remedies  philosophically  indicated  by  the  supposed  theory  to 
which  their  previous  investigations  led  them.  The  Empyrics, 
on  the  other  hand,  discarding  all  inquiry  into  the  origin  and 
cause  of  the  malady,  and  the  constitution  or  idiosyncracy  of  the 
patient,  attempted  its  removal  by  the  administration  of  such 
remedies  as  had  heretofore  been  found  to  give  relief  in  similar 
cases,  however  contrary  they  might  appear  to  any  supposed 
theory  of  the  disease. 

Of  these  two  rival  sects  and  their  opinions,  Celsus  has  given 
us  a  most  interesting  history.  He  himself  servilely  followed 
neither  of  them.  He  reverted  to  the  Hippocratean  doctrine  of 
the  four  humours,  and  like  his  great  master,  in  the  treatment  of 
disease  was  too  prone  to  watch  for  and  rely  upon  the  operations 
of  nature  herself,  a  practice  which  in  acute  diseases  can  never 
be  indulged  in  without  extreme  danger. 


12 


PREFACE. 


Of  the  Dietetics  and  Pharmaceutics,  two  other  rival  sects,  one 
word  is  all  we  can  pause  to  say.  The  former  professed  to  cure 
all  diseases  by  particular  regulations  of  diet,  and  the  latter  relied 
exclusively  upon  the  action  of  drugs. 

All  of  the  different  theories  of  which  I  have  hitherto  spoken 
were  in  vogue  when  Galen  appeared,  to  throw  new  light,  order, 
system  and  sound  philosophy  into  the  science  of  medicine,  which 
undoubtedly  owes  him  much.  But  he  was  not  free  from  the  in- 
fluence we  are  condemning  and  allowed  himself  to  be  swerved 
by  his  own  peculiar  theories.  He  insisted  on  the  existence  of 
three  gases  or  spirits,  which,  he  contended,  exerted  a  peculiar 
influence  upon  the  organs  in  which  they  were  located ;  that  the 
natural  spirit  had  its  abode  in  the  liver,  the  vital  in  the  heart, 
and  the  animal  in  the  brain.  Still  adhering  to  the  notion  of  the 
four  elements  and  four  humours  of  Hippocrates,  and  believing 
the  fluids  to  be  the  seat  of  all  diseases,  he  yet  contrived  to  em- 
barrass that  doctrine  by  so  many  minute  subdivisions  and  fan- 
tastic combinations  as  to  deprive  it  of  the  only  merit  it  had — 
its  simplicity.  Wedded  to  his  theories,  and  like  the  Dogmatists 
forcing  his  treatment  to  conform  to  his  system,  he  closed  his 
eyes  to  a  variety  of  facts  and  phenomena  which  were  daily  sur- 
rounding him,  and  which  it  is  to  be  regretted  so  great  a  mind 
did  not  notice,  record  and  transmit  to  posterity. 

Between  the  times  of  Hippocrates  and  Galen  the  Alexandrian 
school  had  grown  up,  which,  under  the  patronage  of  the  Ptole- 
mies, had  drawn  together  the  professors  and  students  of  medi- 
cine from  all  the  then  known  countries,  and  formed  a  kind  of 
university  from  which  much  might  have  been  expected.  But 
after  the  death  of  Galen,  all  such  hopes  were  disappointed. 


PREFACE. 


13 


Original  genius,  paralyzed,  as  it  were,  by  his  immense  authority, 
suffered  progress  in  the  healing  art  to  cease,  and  obedient  to 
his  nostrums,  men  carried  science  and  rational  practice  no  far- 
ther. It  cannot  be  denied,  that  from  his  death,  medical  science 
declined.  That  individual  merit  continued  to  live  in  it,  such 
names  as  Sextus  Empyricus  and  others  prove.  But  medicine 
took  no  active  march  until  the  prevalence  of  the  teachings  of 
the  Arabian  school. 

The  accidental  preservation  of  the  writings  of  Hippocrates 
and  Galen,  at  the  destruction  of  the  Alexandrian  library,  gave 
to  the  few  Mahometan  men  of  genius  a  turn  towards  medical 
inquiry.  Several  Arabian  physicians  of  eminence  flourished. 
The  names  of  Avicenna,  Avinzoa,  Avaroes  are  too  well  known 
to  require  even  mention  from  us.  It  is  true  that  to  them  we 
owe  no  theoretical  progress.  Not  original  in  their  character, 
their  theories  were  based  upon  the  writings  of  their  Greek  pre- 
decessors. Yet  their  industry  was  the  means  of  introducing 
to  the  profession  many  remedial  agents  not  before  known,  of 
which,  when  tegetable,  their  climate,  soil,  and  overland  com- 
merce with  the  more  distant  East,  were  singularly  prolific ;  and 
candour  compels  us  to  acknowledge  that  to  them  is  due  the  im- 
provement of  extracting  from  vegetable  substances  their  more 
active  principles,  thereby  giving  rise  to  the  chemical  school,  and 
the  special  art  of  the  apothecary! 

Chemistry,  that  noble  science,  emerging  from  the  obscurity 
in  which  it  had  been  so  long  detained  by  the  alchymists — those 
blind  and  greedy  searchers  after  the  philosopher's  stone,  which 
was  supposed  to  have  the  power  to  commute  all  metals  into  gold 
— and  profiting  by  all  that  had  been  really  valuable  in  their 
labours,  (the  preparations  of  mercury,  antimony,  and  other 


14  PREFACE. 

medicines  of  metallic  bases,  being  almost  exclusively  due  to  the 
alchymist,)  became  of  incalculable  influence  in  the  practice  of 
medicine.  But,  like  every  thing  else  useful,  carried  too  far 
when  attempted  to  be  reduced  to  a  universal  system,  it  was 
applied  by  a  medical  sect  to  explain  the  causes  of  life,  disease 
and  death.  The  various  parts  of  the  human  body,  they  en- 
deavoured to  subject  to  a  chemical  analysis,  (an  analysis  which, 
in  those  times,  must  have  been  very  imperfect,  and  for  the  most 
part  conjectural,)  and  such  remedies  were  employed  for  the  cure 
of  diseases,  which  were  supposed  to  be  analogous  to  the  chemical 
composition  of  the  vital  organs.  As  if  chemistry  could  create ! 
as  if  the  living  body  could  be  acted  on  by  the  same  process  as 
the  matter  of  which  they  supposed  it  to  be  composed  in  its  inert 
and  unorganized  state. 

At  the  head  of  this  school  stood  Paracelsus,  the  greatest  and 
most  sublime  of  quacks,  in  ancient  or  modern  times.  He  pre- 
tended to  have  discovered  the  great  panacea,  the  universal  cure 
of  all  diseases,  the  vain  dream  of  the  older  alchymists — not 
without  interest  for  its  tinge  of  romance — which  he  professed  to 
hold  concealed  in  the  hilt  of  his  dagger,  an  imposture  which  his 
own  death  satisfactorily  exposed.  He  publicly  burnt  the  writings 
of  Galen,  on  the  grounds  that  they  could  no  longer  be  of  any 
utility,  and  were  calculated  to  check,  by  their  authority,  the 
discovery  and  advancement  of  truth.  Nor  did  he  and  his  fol- 
lowers disdain  to  resort  to  astrology  and  magic,  vain  incanta- 
tions, idle  rites  and  ceremonies  in  the  treatment  of  their  patients. 
Sad  comment  on  the  superstition  of  the  age  in  which  he  lived ! 

Between  this  school  and  the  Galenists,  an  exterminating  war 
was  for  a  hundred  years  carried  on,  and  cannot  be  said  to  have 
finally  terminated  till  the  seventeenth  century.   They  persecuted 


PREFACE. 


15 


each  other  with  an  unrelenting  activity,  to  which  the  annals  of 
religious  bigotry  can  alone  furnish  a  parallel.  It  is  not  for  us  to 
estimate  the  comparative  merits  of  these  two  schools.  It  may 
suffice  to  say  that  if  the  former  was  too  "expectant,"  the  latter 
was  too  daring  and  experimental  in  the  treatment  of  disease. 

At  length  the  Galenists  gave  way  to  a  gradual  revival  and 
preference  of  the  doctrines  and  practice  of  Hippocrates  and  the 
Chymists,  to  what  we  shall  call  the  modern  chemical  school. 
This  last,  under  the  lead  of  such  great  men  as  Sylvius  and  Wil- 
lis, and  Sydenham,  applying  chemical  knowledge,  now  truly 
scientific,  with  physiology,  which  the  practice  of  anatomy  had 
by  this  time  made  a  certain  science,  discarding  the  vagaries  of 
their  predecessors,  Paracelsus  and  company,  yet  not  divested  of 
the  Hippocratian  theory,  that  the  fluids  are  the  seat  of  all 
diseases,  that  the  fluids  themselves  are  the  result  of  a  certain 
chemical  fermentation  of  the  material  elements  of  the  human 
body,  some  of  which  fluids,  in  the  healthy  action  of  this  kind  of 
human  still,  should  be  acid,  others  alkaline,  and  that  disease  is 
caused  by  the  deranged  fermentation  of  these  fluids,  and  their 
improper  production  ;  for  instance,  that  fever  arises  from  the  too 
great  acidity  of  those  fluids  which  ought  to  be  alkaline,  and  in 
the  treatment  of  disease,  faithful  to  the  before  quoted  axiom : 
"contraria  contrariis  carcuitur :"  they  administered  acids  or 
alkalies,  respectively,  according  to  the  supposed  diagnosis.  As 
a  rare  proof  of  the  imprudence  of  rejecting  entirely  any  pro- 
posed system,  experience  has  established  the  fact  that  alkalies 
are  valuable  remedies  in  cases  of  fever ;  but  this  by  no  means 
proves  the  correctness  of  the  theory,  nor  justifies  the  attributing 
all  diseases  to  one  common  cause. 

Even  this  modern  chemical  sect  had,  in  its  turn,  to  give  way 


16 


PREFACE. 


to  a  new  system,  a  new  school.  The  mathematical,  or  rather 
mechanical  physicians,  making  extreme  deductions  from  the 
truth  that  the  construction  of  the  skeleton,  the  muscular  action, 
the  motion  of  the  limbs  and  other  large  organs,  are  evidently 
mechanical,  taught  that  all  the  vital  system  was  constructed  on 
the  same  principles,  controlled  by  similar  motive  powers,  and  in 
like  manner  subject  to  the  laws  of  gravity  and  impulsion. 
Looking  upon  the  whole  body  as  a  kind  of  machine,  put  together 
upon  the  principles  of  hydraulics  and  hydrostatics,  composed  of 
its  tubes,  canals,  &c,  they  could  consider  disease  in  no  other 
light  than  as  the  consequence  of  the  obstruction,  or  laxity,  or 
other  derangement  of  these  mechanical  forces,  arising  from  the 
contraction  or  enlargement  of  the  pores,  &c.  This  system  for  a 
long  time  prevailed.  A  glance  of  the  mind  will  convince  any 
one,  that  its  indiscriminate  pursuit  in  the  treatment  of  disease, 
would  occasion  the  alternate  abuse  of  purgatives  and  astringents, 
stimulants  and  narcotics,  according  to  the  supposed  seat  and 
cause  of  the  special  disease.  Yet  even  this  school  has  con- 
tributed its  share  to  the  progress  of  medical  science,  by  causing 
to  be  more  minutely  studied  and  explained  a  variety  of  pheno- 
mena ;  the  vermicular  motion  of  the  bowels,  for  instance,  which 
without  it  would  have  remained  much  longer  unknown. 

Pending  the  Contest  between  these  two  opinions,  appeared 
Van  Helmont,  in  Holland,  who  laid  the  foundation  of  a  new 
sect — the  Yitalists.  He  was  followed  by  Stahl,  who  enlarged 
and  improved  upon  the  theory  of  his  predecessor.  They  taught 
that  the  functions  of  life  depend  neither  upon  a  chemical  nor  a 
mechanical  action ;  that  the  organs  of  the  body  are  of  themselves 
inert,  and  controlled  by  a  certain  invisible  and  unsubstantial 
spirit,  or  agent,  which  the  former  called  archeus,  and  the  latter 


PREFACE. 


17 


anima;  that  it  was  the  business  of  this  agent  (which  they  did 
not  suppose  to  be  an  intelligent  and  independent  being,  but  a 
kind  of  property  of  the  living  body,)  to  preserve  the  body  in 
health,  to  prevent  its  natural  tendency  to  plethora — for  that  it 
had  such  a  tendency  was  a  part  of  their  doctrine — to  counteract 
which  was  the  sole  duty  of  the  physician,  to  watch  the  operations 
of  the  supposed  anima,  and  to  co-operate  with  it  by  regulating 
the  evacuations. 

Hoffman,  the  contemporary  of  Stahl,  approaching  nearer  the 
truth,  attributed  the  phenomena  of  life,  health  and  disease  to 
the  exclusive  action  of  the  nervous  system.  To  this  nervous 
influence  he  added  the  supposition  that  diseases,  though  some- 
times originating  in  the  fluids,  more  generally  found  their  seat 
in  the  solids.  He  supposed  the  body  to  contain  a  certain 
moving  fibre,  possessing  a  certain  tone  necessary  to  its  healthy 
action,  spasmodic  or  atonic,  according  to  its  too  great  or  too 
little  action.  How  far  he,  individually,  allowed  his  theory  to 
rule  his  practice,  we  cannot  say;  systematically  followed,  it  is 
clear  that  it  would  indicate  nervous  stimulants  or  anodynes  as 
the  almost  exclusive  remedies. 

Throughout  the  prevalence  of  the  schools  we  have  mentioned, 
the  humoral  pathology  had  maintained  its  sway ;  but  this  was 
destined  now  to  be  utterly  denied,  and  the  Solidists  arose,  who 
taught  that  all  diseases  are  the  results  of  the  morbid  action  of 
the  solids,  although  they  admitted  that  through  them  the  fluids 
might  be  secondarily  affected, — a  doctrine,  though  not  sufficing 
to  establish  a  perfect  theory,  yet  certainly  containing  a  great 
deal  of  truth,  and  which,  to  this  day,  maintains  a  very  general 
prevalence. 

About  this  time  appeared  the  great  Boerhave,  whose  ambition 
2 


18 


PREFACE. 


it  seems  to  have  been  to  form  an  eclectic  school.  He,  indeed, 
selected  from  the  doctrines  of  his  predecessors  whatever  he 
deemed  valuable ;  but  out  of  this  selection  he  built  a  system  of 
his  own,  which,  with  the  authority  of  a  master,  he  passed  upon 
his  pupils,  as  a  system,  and  so  far  fell  short  of  true  eclecticism, 
which  the  University  of  Edinburgh,  in  the  person  of  Cullen, 
was  destined  more  nearly  to  approach.  This  great  physician 
exploded  the  idea  of  there  existing  in  truth  any  one  peculiar 
theory,  of  itself  sufficient  to  account  for  and  relieve  the  symp- 
toms of  all  diseases.  Edinburgh  may  well  glory  in  the  honour 
of  having  produced  him  to  the  world.  He  must  ever  be  looked 
upon  as  a  great  benefactor  of  the  human  race. 

Notwithstanding  the  rationality  of  Cullen's  teachings,  such  is 
the  proneness  of  the  human  mind  to  be  misled  by  the  apparent 
simplicity  of  systems,  which,  attractively  yet  deceitfully,  pro- 
mise science  without  toil,  that  he  found,  in  his  life-time,  and 
from  amongst  his  own  pupils,  too,  a  rival,  who  opposed  his  efforts 
for  the  real  progress  of  medicine,  by  attempting  to  set  up  a  new 
theory.  Brown  taught,  in  the  very  university  where  Cullen 
nourished,  as  a  theory  applicable  to  all  diseases,  that  there  exists 
in  the  body  a  certain  property,  which  he  called  "excitability;" 
that  every  thing  acted  upon  the  body,  through  this  property,  as 
an  excitant,  and  that  disease  is  the  result  of  excessive  or  defec- 
tive excitement;  consequently,  that  its  treatment  must  be  solely 
directed  to  increase  or  diminish  this  excitement,  as  the  case  may 
be,  without  paying  the  slightest  attention  to,  or  endeavoring  in 
the  least  to  allay  the  specific  symptoms  with  which  it  may  be 
attended. 

One  other  practitioner  of  great  eminence  we  cannot  refrain 
from  mentioning,  as  an  instance  of  the  mischief,  we  are  labouring 


PREFACE. 


19 


to  condemn,  of  a  systematic  adherence  in  practice  to  a  favourite 
theory.  We  allude  to  the  celehrated  Broussais.  This  French 
physician,  struck  by  the  constant  recurrence  of  inflammation  in 
so  many  diseases,  especially  in  that  most  numerous  class,  fevers, 
considered  irritation  the  primary  cause  of  all  diseases.  Acting 
on  the  maxim,  "  ubi  irritatio,  ibi  flux"  he  applied  his  whole 
treatment  to  allaying  this  supposed' irritation  or  inflammation,  to 
accomplish  which  he  could  find  no  better  instrument,  one  which 
many  of  his  followers,  at  least,  have  wielded  with  an  unsparing 
hand,  the  indiscriminate  use  of  the  lancet.  To  bleed  locally 
and  generally  was  their  incipient  treatment,  to  which,  if  the 
disease  yielded  not,  re-leech  !  re-cup  !  re-bleed  !  and  when  some 
stalwart  patient  survived  this  drain  of  vital  energy,  behold  the 
cure !  He  was  pointed  out  as  an  instance  of  the  truth  of  the 
theory. 

In  this  hurried  sketch  of  the  different  medical  schools  and 
sects,  we  have  not  spoken  of  the  Anatomists,  because,  incalcu- 
lable as  are  the  services  rendered  to  the  curative  art,  their 
influence  upon  the  practice  of  medicine — our  theme — has  been 
altogether  indirect  in  its  character.  But,  to  give  our  readers 
some  idea  of  the  labours  of  these  great  men,  and  a  specimen  of 
the  gradual  development  by  which  a  knowledge  of  the  human 
body  has  been  acquired,  we  will  trace,  in  a  few  words,  the  suc- 
cessive steps  which  led  to  the  discovery  of  the  circulation  of  the 
blood.  We  cannot  do  this  better,  more  clearly,  nor  yet  more 
briefly,  than  in  the  words  of  England's  eminent  Cardinal,  the 
Archbishop  of  Westminster.  Some  of  our  readers  may  be 
tempted  to  smile  at  our  quoting  from  a  theologian  on  a  medical 
subject,  but  they  must  be  little  aware  of  the  vast  fund  of  general 
and  scientific  knowledge  to  be  found  in  the  writings  of  the  dig- 


20 


PREFACE. 


nitaries  of  the  Church;  and  the  true  disciple  of  the  eclectic 
school  culls  flowers  wherever  they  may  grow,  appreciates  a  gem 
in  whatever  casket.    Cardinal  Wiseman  says : 

"  The  school  at  Padua  had  flourished  for  many  years,  and 
perhaps  it  has  given  to  the  world  the  greatest  series  of  extra- 
ordinary men  in  the  medical  profession  which  it  has  ever  seen 
in  one  place.  Cuvier,  one,  certainly,  of  the  best  authorities  of 
modern  times,  says  that  the  science  of  animal  physiology  is  due 
to  three  men  who  ought  to  be  considered  fathers  of  that  science. 
These  are  Vesalius,  Fallopius,  and  Eustachius.  The  two  first 
belong  to  the  school  of  Padua.  Fallopius  and  Eustachius  applied 
themselves  more  particularly  to  the  examination  of  the  veins, 
which  were  then  but  little  understood  and  known.  Realdus 
Columbus,  a  pupil  and  successor  of  Vesalius,  published  a  work 
upon  the  veins  in  1559 ;  and  for  the  first  time  communicated  the 
knowledge  of  a  really  great  discovery — that  of  the  lesser  circu- 
lation of  the  blood  through  the  lungs.  What  he  had  discovered 
he  makes  known  so  clearly,  that  so  far  there  is  no  doubt  that  it 
belonged  to  him.  The  next  great  man  who  succeeded  Vesalius 
was  Fabricius  ab  Aquapendente,  who  held  the  chair  of  medicine 
at  Padua  for  fifty  years.  The  existence  of  valves  in  the  veins 
had  been  discovered  by  a  Dutch  physician,  Sylvius ;  but  it  was 
Fabricius  who  first  discovered  that  the  valves  of  the  veins  opened 
towards  the  heart,  so  that  he  concluded  and  taught  that  in  the 
veins  the  blood  flows  to  the  heart,  and  cannot  return  from  it. 
Now,  see  how  near  you  are  to  the  circulation  of  the  blood. 
You  need  only  one  element  more ;  you  only  require  to  know  how 
it  flows  through  the  arteries.  Harvey  was  the  pupil  of  Fabricius 
in  Padua.    He  made  one  more  experiment,  and  the  grand  dis- 


PREFACE. 


21 


covery  was  made.  It  is  only  wonderful  that  it  had  not  occurred 
to  his  venerable  preceptor.  He  made  a  ligature  of  an  artery ; 
he  found  that  the  inturgescence  of  the  artery  caused  by  the 
arrest  of  the  blood,  was  above,  not  below  the  ligature,  and  there- 
fore established  that  the  blood  is  propelled  from  the  heart  to  the 
extremities  through  the  arteries,  and  then  returns  through  the 
veins  to  the  heart.  Thus  he  incorporated  in  his  discovery  what 
had  already  been  established  by  Columbus  and  Fabricius.  Now, 
is  not  glory,  and  very  great  honor  due  to  the  men  who  prepared 
the  way  for  this  great  discovery,  and  are  they  not  entitled  to 
share  it  with  Harvey?" 

But  why  should  we  dwell  any  longer  in  examining  the  diver- 
sity of  opinion  and  practice  in  those  who  have  gone  before  us  ? 
Is  not  the  mischief  of  an  exclusive  adherence  to  false  theory 
'  sufficiently  manifest  among  us  ?  Is  there  a  physician  that  has 
not  his  peculiar  notion,  and  consequently  a  practice  of  his  own  ? 
One  traces  the  origin  of  all  diseases  to  the  liver,  another  to  the 
heart,  a  third  to  the  spinal  column,  a  fourth  to  the  nervous  sys- 
tem, a  fifth  to  the  digestive  apparatus,  and  so  on. 

More  "pathies"  exist  than  we  have  time  or  inclination  to 
describe,  but  however  unpleasant  the  task,  on  account  of  their 
general  prevalence,  and  because  we  have  ourselves  given  them  a 
thorough  test,  we  feel  it  a  duty  to  speak  with  candor  upon  two. 
We  mean  Homeopathy  and  Hydropathy. 

And  for  the  first.  Finding  that  a  burn  could  be  sometimes 
cured  by  the  approach  of  the  burnt  part  to  the  fire,  noticing 
the  specific  effect  of  preparations  of  bark  in  the  cure  of  inter- 
mittent fevers,  Hahneman,  from  behind  the  mountains  of  Saxony, 
invented  and  proclaimed  to  the  world  his  new  theory  ;  that  those 


22 


PREFACE. 


remedies  will  cure  the  disease  which  produce  its  symptoms  in  the 
well  person,  and  the  medical  world  stood  in  astonishment  at  the 
announcement  of  the  new  maxim  :  "  similia  similibus  curantur" 
Halmeman  lacked  not  ingenuity  to  sustain,  by  plausible  argu- 
ments, his  new  idea,  and  seconded  his  notion  by  the  Hippo- 
eratean  doctrine  of  watching  and  assisting  nature,  and,  as  he 
extended  it,  anticipating  her  action.  Joined  to  this,  he  taught 
that  the  nerves  are  the  seat  of  all  diseases,  and  this  portion  of 
the  human  frame  being  the  most  susceptible,  he  came  to  the 
conclusion  that  the  remedies  he  recommended  should  be  exhibited 
•in  doses  inflnitesimally  small.  Like  most  other  theories,  his 
system  has  not  been  without  its  use.  In  some  maladies  of  a 
chronic  character,  the  former  part  of  his  theory  may  be  bene- 
ficially employed,  his  error  consisting  in  applying  it  in  both  its 
parts  to  all  diseases.  Any  practical  physician  knows,  that  in 
acute  and  inflammatory  cases,  in  those  diseases  which  so  sud- 
denly attack  and  so  speedily  and  fatally  terminate,  such  a  prac- 
tice would  be  worse  than  idle,  for  even  the  most  active  remedies, 
and  the  most  prompt  in  their  operation,  are  sometimes  and  too 
often  inefficient. 

The  second  can  be  more  summarily  disposed  of.  Doctor 
Stewart,  of  London,  in  a  lecture  before  the  classes  of  the  Mid- 
dlesex Hospital,  has  already  done  it  to  our  hand.  He  thus 
describes  the  Hydropathists,  the  enlightened  and  philosophical 
followers  of  Doctor  Pressnitz  :  "  those  who  profess  to  cure  every 
disease  by  packing  in  a  wet  sheet,  and  flushing  the  sewers  of  the 
animal  microcosm  twice  a  day  with  oceans  of  cold  water." 

From  this  review  of  the  vagaries  of  the  human  mind,  from 
which  so  many  and  so  great  men  have  not  been  exempt,  out  of 
these  contradictions  and  conflicts  of  opinion,  what  lesson  should 


PREFACE.  23 

the  wise  physician  learn  ?  No  theory  so  absurd  but  may  contain 
some  germ  of  truth,  and  none  so  well  established  as  to  com- 
mand a  blind  obedience.  No  observation  of  facts,  no  applica- 
tion of  remedies  from  experience  of  their  good  effects,  can  make 
the  physician,  unless  he  understands  the  physiology  and  patho- 1 
logy,  the  constitution,  construction,  normal  and  abnormal  action 
of  the  human  body.  And,  on  the  other  hand,  no  science  so 
complete,  no  theoretic^finformation  so  copious,  can  suffice  to 
form  the  medical  character,  without  the  strictest  attention  to 
the  most  minute  observation  of  facts  and  phenomena,  and  a  just 
regard  to  the  experience  of  others  in  the  application  of  medici- 
nal agents.  Truth  is  generally  found  between  extremes.  And 
the  eclectic  physician,  as  his  name  implies,  culls  from  all  theories 
what  they  may  contain  of  good,  and,  free  from  prejudice  and 
bigotry,  never  disdains  a  practice  which  experience  and  reason 
have  proved  to  be  beneficial ;  at  the  same  time  he  is  no  slave  to 
antiquity,  no  violent  hater  of  novelty.  He  knows  no  dread  of 
innovation,  simply  as  such,  and  is  as  ready  to  avail  himself  of 
any  new  lights  and  discoveries,  as  he  is  considerate  and  regard- 
ful of  the  past. 

Unfortunately,  there  is  too  great  a  tendency  in  the  human 
family  to  adhere  with  dogmatical  tenacity  to  old  errors,  rather 
than  search  after  truth,  and  even  truth,  when  ascertained,  is 
often  rejected,  or  with  too  much  reluctance  adopted.  When 
Harvey  discovered,  or  rather  demonstrated  the  circulation  of 
the  blood — to  which  we  have  already  had  occasion  to  allude — 
history  tells  us,  that  not  a  single  physician  in  England,  over 
forty  years  of  age,  appreciated  or  acquiesced  in  the  discovery. 
Even  at  the  present  day,  an  old  physician  of  high  reputation, 
Doctor  Cartwright,  of  New  Orleans,  forgetting  that  a  fact  once 


24  PREFACE. 

affirmatively  proved  can  never  afterwards  be  overthrown,  has 
published  a  new  hypothesis  upon  this  subject.  Times  have  been, 
when  to  promulgate  a  new  discovery,  was  to  invite  persecution, 
and  to  be  the  open  advocate  of  a  new  truth,  frequently  led  to 
the  prison  or  the  stake.  Mankind  seems  to  have  an  appetite  for 
falsehood.  And  when  a  truth  is  for  the  first  time  ascertained 
and  promulgated,  many  persons,  too  ignorant  to  investigate,  too 
stupid  to  comprehend,  or  too  bigoted  to  admit,  stir  up  the  pre- 
judices of  the  unlettered  multitude,  and  after  having  cried  on 
the  pack,  are  reckless,  for  their  part,  if  the  truth  itself,  were  it 
possible,  should  perish  with  its  advocates.  Enoch  and  Noah,  as 
a  great  man  said,  were  not  the  only  ones  derided  by  the  multi- 
tude for  adherence  to  duty.  Truth  has  always  had  her  martyrs. 
Socrates,  with  smiles  received  the  hemlock — the  popular  reward 
of  his  labours  and  devotion  for  his  country  and  his  race. 

No  matter  how  beneficial  to  the  human  family,  no  matter  how 
calculated  to  relieve  suffering,  let  a  mode  of  cure  be  new,  it  is 
met  with  sweeping  denunciations  of  humbug  and  quackery. 
Pretension,  alas  !  is  more  common  than  knowledge.  An  empty 
nod  from  an  old  official  head  has,  too  often,  more  influence  over 
the  masses  than  real  merit  in  the  young.  He  who  has  the  man- 
liness to  lift  up  his  voice  in  defence  of  newly  discovered  truth 
against  old  theory,  though  acting  in  behalf  of  the  best  interests 
of  the  human  family,  is  too  often  doomed  to  penury  and  perse- 
cution. Such  has  been  the  case  in  our  own  day,  and  in  this 
land  of  liberty.  But  "the  school-master  is  abroad  in  the  land," 
and  we  may  hope  to  realize  a  better  state  of  things.  Hence- 
forth, those  who  would  sway  and  control  public  opinion  in  respect 
of  science,  must  themselves  be  scientific.  Age,  as  age,  can 
claim  no  extra  privilege,  unless  the  mind  has  been  improved  in 


PREFACE. 


25 


proportion.  The  will  of  the  old  doctor  is  no  longer  omnipotent, 
and  his  ipse  dixit  has  ceased  to  be  oracular. 

The  true  school  of  medicine,  the  Eclectic  school,  may  now  be 
said  to  reign — a  school  that  is  no  slave  of  antiquity,  while  no 
encourager  of  rash  experiment.  Eclecticism  teaches,  not  to 
attribute  diseases  to  one  common  cause,  but  to  behold  in  them 
the  operation  of  an  immense  variety  of  internal  and  external 
causes,  the  exact  and  respective  influence  of  which  it  is  extremely 
difficult  to  ascertain.  Does  Eclecticism  lay  herself  down  at  the 
feet  of  old  authority?  No!  Does  she  run  after  every  new 
fangled  doctrine  ?  No !  Does  she  galvanize  into  existence 
exploded  theories  ?  No  !  Does  she  strain  the  intellect  and  per- 
vert facts,  to  find  reasons  for  a  new  theory  ?  No !  Steering 
safely  between  Scylla  and  Charybdis,  she  looks  upon  no  phe- 
nomenon as  too  humble  to  arrest  her  attention,  no  precedents  so 
respectable  as  to  challenge  their  imitation.  "With  a  diligence 
untiring,  she  investigates  the  cause  of  the  disease ;  with  indi- 
vertible patience  and  magnetic  certainty,  she  watches  its  symp- 
toms and  progress ;  and,  as  a  sound  philosophy  indicates,  applies 
the  remedy  which  experience  has  approved.  In  this  school 
have  we  studied,  in  this  school  have  we  laboured,  and  the  follow- 
ing pages  are  our  feeble  tribute  to  the  profession  we  love. 

We  have  not  taken  up  an  ambitious  pen,  nor  written  with  the 
expectation  of  distinction  or  reward.  Upon  the  call  of  our 
brethren,  we  have  crudely  and  hastily,  in  the  midst  of  distract- 
ing cares  and  anxieties,  thrown  together  our  experience ;  we 
have  mingled  with  it  some  unsophisticated  reasonings,  and  sub- 
mitting the  work  to  an  indulgent  public,  we  trust  that  it  may 
be  of  some  utility. 

Houston,  Texas,  Sept.  1853. 


26  PREFACE. 

Kote. — Not  Laving  the  original  authorities  at  hand,  in  the  historical  portions 
of  the  foregoing  preface,  we  have  relied  upon  the  able  compilation  of  Doctor 
Boztock,  the  correctness  of  whose  citations  of  ancient  writers,  we  once  had  an 
opportunity  to  verify.  We  shall  never  forget  the  impression  his  able  work  on 
the  History  of  Medicine  made  upon  us,  many  years  ago,  when  we  first  entered 
upon  its  study,  and  we  regret  that  circumstances  have  never  since  enabled  us  to 
give  it  a  re-perusal.  We  have  not  attempted  a  strictly  chronological  order,  and 
had  to  rely  greatly  on  memory.  We  by  no  means  present  it  as  a  complete 
account  of  the  matters  on  which  it  treats,  but  convinced  that  such  a  treatise  as 
it  contemplates  would  be  useful  to  the  profession,  and  in  the  hope  that  it  might 
be  suggestive  to  some  abler  pen. 


GENERAL  PREFACE, 


You  are  aware  that  this  volume  was  solicited  by  my  medical 
brethren ;  I  have  endeavoured  to  write  a  purely  scientific  work, 
and  at  the  same  time  have  tried  to  compose  it  in  a  simple  and 
popular  style,  which  renders  abstruse  subjects  comprehensible 
and  even  entertaining  to  the  general  reader.  We  are  not  of 
that  class  who  believe  every  man  capable  of  being  his  own 
doctor,  and  candor  and  truth  compel  us  to  give  you  warning, 
that  he  who  is  not  thoroughly  acquainted  with  anatomy  and 
physiology,  should  not  tamper  with  medicine,  unless  in  cases  of 
emergency. 

I  claim  for  the  work  something  more  than  a  mere  compilation. 
I  have  consulted  numerous  works,  and  I  profess  I  am  indebted 
to  each  for  some  of  the  best  materials  in  them.  Where  quota- 
tions appear,  I  have  named  the  author,  or  noted  the  part  as 
quoted. 

I  have  written  this  work  at  the  solicitation  of  my  friends, 
unaided  and  unadvised ;  and  disrobing  myself  of  those  declara- 
tions of  diffidence  that  seem  to  depress  some  authors,  and  view- 
ing honestly  and  candidly  that  such  feelings  are  most  chastely 
felt  when  they  are  least  expressed,  I  have  only  to  assure  you 
that  this  work  was  written,  as  I  before  observed,  in  the  midst  of 
many  distracting  cares.  Imperfect  as  it  may  be,  I  respectfully 
present  and  submit  it  to  the  public  taste,  confident  it  will  meet 
the  fate  it  justly  claims. 


TABLE  OF  CONTENTS. 


PREFACE. 

With  a  Condensed  History  of  the  Science  of  Medicine  to  the  present  time, 

INTRODUCTION. 
Practical,  General,  and  Local  Remedies. 

MEDICINES  AND  THEIR  USES. 

GENERAL  DIAGNOSIS. 
The  Faculty  of  distinguishing  one  Disease  from  another. 

GENERAL  PROGNOSIS. 
The  Course  and  Termination  of  Disease. 

THE  PULSE. 

The  Mode  and  Manner  to  be  adopted  in  examining  the  same,  and  its  Patholo- 
gical conditions. 

SPECIAL  PATHOLOGY  AND  THERAPEUTICS. 
General  Diseases. 

1.  Idiopathic  Fever. 

2.  Remote  Causes  of  Fever. 

3.  The  Origin  of  all  possible  Cause  of  Fever. 


30 


TABLE  OF  CONTEXTS. 


FEVERS.— FEBRES. 

Intermittent,  an  J  Ague,  and  Fever. — Febres  Intermittens. 

1.  Quotidian,  Paroxysms  coming  on  every  24  hours. 

2.  Tertian,  Paroxysms  coming  on  every  48  hours. 

3.  Quartan,  Paroxysms  coming  on  every  72  hours. 
Simple  Remittent  Fever. — Febres  Remittens. 
Continued  Fever. 

Typhus  Fever,  Typhus  Mitior. 
Congestive  Fever,  Febris  Con-gestia. 
Yellow  Fever,  Typhus  Ictcrodes. 

EXANTHEMATICA— ERUPTIVE  FEVERS. 
Small  Pox. —  Variola. 
1.    Distinct.  2.  Confluent. 

Varioloid,  Variola — Small  Pox  in  a  modified  form. 
Varicella. 
Chicken  Pox. 

Measles,  Rubeola  or  Mobilli. 
Scarlet  Fever — Scarlatina. 
Dengue. 

CONSTITUTIONAL  DISEASES. 

1.  Rheumatism. 

2.  Gout. — Podagra. 

INFLAMMATIONS. — PHLEGMASIA. 

1.  Phlegmon — Phlegmonons  Inflammation. 

2.  Erysipelas — Erysipelatous  Inflammation. 

3.  Erysipelas  of  Children. 

DISEASES  OF  THE  BRAIN. 
Inflammation  of  the  Brain  and  its  Membranes. — Phrenitis. 

DISEASES  OF  THE  EYE. 

1.  Inflammation  of  the  Eye.— Ophthalmia — Simple  Conjunctivitis. 

2.  Chronic  Inflam.  of  the  Eye. — Chronic  Ophthalmia. 

3.  Catarrhal  and  Purulent  Opthalmia. 

4.  Gonorrhoeal  Opthalmia. 

5.  Scrofulous  Opthalmia. 

Dimness  of  Sight. — Amaurosis. 


TABLE  OF  CONTEXTS. 


DISEASES  OF  THE  LIVER  AND  ITS  APPENDAGES. 

Inflammation  of  the  Liver  or  Hepatitis. 

Induration,  Softening,  etc. 
Jaundice. — Icterus. 

DISEASES  OF  THE  SPLEEN. 

1.  Acute  Inflammation  of  the  Spleen. — Acute  Splenitis. 

2.  Chronic  Inflammation  of  the  Spleen. — Chronic  Splenitis. 

DISEASES  OF  THE  PULMONARY  TISSUE  AND  PLEURA. 

1 .  Winter  Epidemics. 

2.  Miasma. — A  Cause  of  Pulmonary  Disease. 

3.  Inflammation  of  the  Pleura,  or  Pleurisy. 

4.  Inflammation  of  the  Lungs  or  Pneumonia. 

5.  Inflammation  of  the  Bronchia,  or  Bronchitis,  Acute  and  Chronic. 

6.  Various  Organic  Affection  of  the  Lungs. 

7.  Pulmonary  Consumption,  or  Phthisis  Pulmonalis. 


DISEASES  OF  THE  STOMACH. 

1.  Inflammation  of  the  Stomach  or  Gastritis. 

2.  Chronic  Inflammation  of  the  Stomach,  or  Chronic  Gastritis. 

3.  Indigestion  or  Dyspepsia. 

4.  Nausea  and  Vomiting,  or  Vomitus. 

5.  Heartburn  or  Gastralgia. 


DISEASES  OF  THE  INTESTINES,  STOMACH,  AND  BOWELS. 


1.  Inflammation  of  the  Small  Intestines,  or  Enteritis. 

2.  Constipation  or  Obstipatis, 
8.  Dysentery,  or  Dysenteria. 

4.  Diarrhoea,  or  Purging. 

5.  Colic,  or  Colica. 

6.  Flatulent  Colic,  or  Colica  Flatulenta. 

7.  Bilious  Colic,  or  Colica  Biliosa. 

8.  Painters  Colic,  or  Colica  Pictonum. 

9.  Constipated  Colic,  vulgarly  called  "  Patent  Dry  Belly  Ache." 

10.  Piles — Ilcemorrhoids. 

11.  Falling  of  the  Fundament,  or  Prolapsus  Ani. 

12.  Diseases  of  the  Stomach  and  Bowels,  conjointly. 


1.  Catarrhal. 


2.  Tubercular. 


8, 


Difficult  Respiration. — Asthma  or  Phthisic. 


82 


TABLE  OF  CONTENTS. 


13.  Cholera  Morbus,  or  Puking  and  Purging. 

14.  Cholera. 

15.  Cholera  Infantum,  or  Vomiting  and  Purging  of  Infants. 

DISEASES  OF  THE  MOUTH  AND  THROAT. 

1.  Diffused  Inflammation,  Aphthae  or  Thrush. 

2.  Ulceration  Inflammation,  or  Canker — Cancrum  Oris. 
8.    Inflammation  of  the  Tonsils,  or  Tonsillitis. 

4.  Croup — Catarrhal  and  Pseudo  Membranous — Cynanche  Trachealis 

5.  Mumps — Cynanche  Parotedea. 

DISEASES  OF  THE  URINARY  ORGANS. 
Inflammation  of  the  Kidneys,  or  Nephritis.. 
Inflammation  of  the  Bladder,  or  Cystitis. 
Chronic  Inflammation  of  the  Bladder,  or  Chronic  Cystitis. 
Suppression  of  Urine — Ischuria  Dysuria. 
Retention  of  Urine. 
Dacontinence  of  Urine  —Eneuresis. 
Immoderate  flow  of  Urine — Diabetis. 

1.    Lnsepidus.  2.  Meletus. 

DISEASES  OF  THE  SKIN. 

1.  Vesicular  Diseases,  Tetter  or  Herpes. 

2.  Scaly  Diseases,  Itch — Scabus  or  Psora. 

3.  Carbuncle,  or  Anthrax. 

4.  Malignant  Carbuncle. 

5.  Cytogamus  Affections — Scald  Head — Tinea  Capitis. 

6.  Nettle  Rash,  or  Urticaria. 

DISEASES  OF  THE  NERVES,  VEINS,  AND  BRAIN. 

CONVULSIVE  DISEASES. 

1.  Nervous  Headache —  Cephalalgia. 

2.  Neuralgia,  or  Tic  Doloreaux. 

1st.  Facial  Neuralgia,  (Lip)      2d.  Lumbago.      3d.  Sciatica,  Pain  in  the  Hip. 

3.  Epileptic  Fits — Epclipsia. 

4.  Apoplexy — Apoplezia. 

5.  Whooping  Cough — Pertussis. 

6.  Hiccough,  or  Singuttus. 

7.  St.  Vitus'  Dance — Chorea. 


1. 

o 

3. 
4. 
5. 
6. 


TABLE  OF  CONTENTS. 


33 


8.  Convulsions  of  Children — Convulsiones. 

9.  Tetanus — Cramps. 

1st.  Body  thrown  backwards — Opisthotonos. 
2d.  Body  bent  forwards — Emprosthotonos. 
3d.  Body  thrown  to  one  side — Plcurosthotonos. 
4th.  Lock  Jaw — Trismus,  Confined  to  the  Jaw. 

10.  Lock  Jaw  of  Infants — Trismus  Nascentium. 

11.  Deleriuni  Tremens — Mania-a-potu. 

12.  Paralysis — Palsy. 

13.  White  or  Tumid  Leg — Phlegmasia  Dolens,  or  Crural  Phlebitis. 

HEMORRHAGES. 

DISEASES  OF  THE  BLOOD  AND  BLOOD-VESSELS  CONJOINTLY. 

1.  Hemorrhage  from  the  Nostril — Epistaxis. 

2.  Hemorrage  from  the  Lungs — Hcemoptysis. 

3.  Hemorrhage  from  the  Stomach — Hozmatamesis. 

4.  Hemorrhage  from  the  Urinary  Organs — Hcematuria. 

5.  Hemorrhages  from  the  Uterus — Womb — Hcemorrhagia. 

6.  Flooding — Excessive  Uterine  Hemorrhage. 

7.  Hemorrhage  from  the  Bowels — Jleloenae. 

DISEASES  OF  THE  SEROUS  AND  CELLULAR  TISSUE. 

1.  Dropsy  of  the  Abdomen — Ascites. 

2.  Ovarian  or  Encysted  Dropsy. 

3.  Dropsy  of  the  Brain — Hydrocephales. 

4.  Dropsy  of  the  Chest,  or  Hydrothorax. 

5.  Dropsy  of  the  Scrotum — Hydrocele. 

6.  Anasarca  Dropsy  of  the  Cellular  Membrane,  or  General  Dropsy. 

VENEREAL  DISEASES. 

1.  Clap — Gonorrhea. 

2.  Pox — Syphilis  or  Lues  Venera. 

3.  Impotency — Anaphrodisia. 

DISEASES  OF  THE  ABSORBENT  SYSTEM. 

SCROFULOUS  DISEASES. 

1.  Kings  Evil — Scrofula. 

2.  Rickets— Rachitis. 

3.  White  Swelling — Ilydrarlhos. 

3 


34  TABLE  OF  CONTENTS. 


DISEASES  OF  THE  EAR. 


1.  Inflammation  of  the  Ear — Otitis. 

2.  Deafness — Paracusis 


DISEASES  OF  THE  ORGANS  OF  REPRODUCTION. 

1.  Retention  of  the  Menses — Amenorrhea. 

2.  Suppression  of  the  Menses — Amenorrhoea  Suppressiones. 

3.  Difficult  Menstruation — Dysmenorrhea. 

4.  Whites —  Leucorrhoza  or  Flour  Atbus. 

5.  Falling  of  the  Womb — Prolapsus  Uteri. 

DISEASES 

THAT  I  HAVE  NOT  REFERRED  TO  ANY  PARTICULAR  CLASS. 

1.  Scurvy — Scorbutus. 

2.  Tumors — Tumores. 

3.  Sprain — Luxatio. 

4.  Ulcer —  Ulcus. 

5.  Worms —  Vermes. 

6.  Scalds  and  Burns — Vulmus  ex  Ustione  Factum. 

7.  Frostbitten — Gelatus. 

8.  Teething — Dentitio. 

9.  Milk  Fever — Febris  Lactre. 

10.  Excoriated  Nipples — Papillce  Excoriated. 


OPERATIVE  SURGERY,  ETC. 


PRACTICE  OF  MEDICINE. 


Practical,  General  and  Local  Remedies. 

An  ill  directed  application  of  almost  any  remedy  may 
lead  to  grave  errors  and  may  cost  lives.  And  every 
practitioner  of  medicine  should  be  fully  impressed  with 
the  importance  of  this  fact,  and  at  the  same  time  be  well 
informed  as  to  the  most  scientific  modes  of  applying 
them ;  this  can  only  be  done  by  investigating  all  of  the 
different  theories,  embracing  those  facts  and  remedies 
which  we  deem  to  be  valuable,  and  discarding  that  which 
to  us  may  seem  absurd.  By  adopting  this  rule  we 
will  be  well  informed  as  to  the  resources  of  our  art, 
and  our  exertions  will  seldom  result  in  failure,  but  by 
adopting  one  theory,  you  may  embrace  a  wrong  mode 
of  applying  remedies,  which  is  sure  to  result  in  a  positive 
harm. 

We  will  have  many  remedial  measures  to  recommend 
in  this  work,  some  of  which  we  flatter  ourselves  are 
generally  unknown  to  the  profession.  Our  object  is  to 
lay  before  you  a  practical  work,  one  that  every  line  may 
be  relied  upon,  and  in  doing  so  we  will  commence  with 
the  use,  the  abuse,  and  still  more  common  neglect  of 
BATnixG.    We  have  no  remedial  means  more  generally 


36 


PRACTICE  OF  MEDICINE. 


available,  and  none  more  capable  of  exerting  a  benefi- 
cial influence ;  it  has,  however,  power  to  do  evil  as  well 
as  good,  and  it  requires  some  skill  to  apply  properly  cold 
or  warm  water,  and  still  more  vapor  or  medicated  baths. 

You  have  frequently  heard  parents  talk  of  hardening 
their  children  by  exposing  them  to  all  vicissitudes  of 
weather,  teaching  indifference  in  regard  to  the  variations 
of  temperature.  This  process  is  often  put  into  practice 
with  children  of  delicate  constitution,  and  to  such  it  is 
very  hazardous.  The  experiment  should  never  be  tried 
on  any  child  or  person  who  is  the  least  unsound,  or  has 
a  scrofulous  diathesis. 

The  best  and  most  direct  mode  of  guarding  the  body 
against  injury  from  cold,  is  probably  afforded  by  the  use 
of  the  cold  bath  or  shower  bath.  When  this  is  taken 
in  the  morning,  or  at  least  every  other  morning,  the 
surface  of  the  body  becomes  familiar  or  inured  to  a  de- 
gree of  cold,  greater,  it  is  probable,  than  it  is  likely  to 
encounter  during  the  remainder  of  the  day ;  and  it  is 
extremely  fortunate  that  we  possess  a  criterion  of  the 
propriety  of  continuing  this  expedient ;  for  instance,  when 
the  sense  of  cold  does  not  remain  long,  but  is  followed 
by  a  glow  of  warmth,  the  cold  shower  bath  is  sure  to  clo 
good.  If,  on  the  other  hand,  however,  after  you  have 
taken  the  bath,  headache  supervenes,  and  you  feel  chilly 
and  languid,  it  should  at  once  be  abandoned,  at  least  for 
a  while. 

By  observing  these  simple  rules,  you  can  make  your- 
self and  children  hardy,  without  the  risk  which  their 
neglect  would  impose.  Whilst  upon  this  subject  I  would 
remark  that,  cold  ivater  is  preferable  to  warm,  as  a  gene- 
ral rule ;  the  former  has  a  tendency  to  produce  active 
reaction,  and  less  apt  to  occasion  a  chill. 


WET  SHEET. 


37 


WET  SHEET. 

This  is  an  invaluable  remedy  in  many  instances; 
when  properly  applied,  it  has  a  great  tendency  to  pro- 
duce reaction  in  debilitated  patients,  who  would  not  be 
enabled  to  endure,  probably,  the  application  of  cold  in 
any  other  mode;  in  its  application,  however,  I  have 
generally  succeeded  best  by  immersing  the  sheet  in  weak 
lye,  which  can  be  done  by  adding  saleratus  to  the  bath. 
This  application  is  strengthening,  and  if  there  is  hyper- 
remia  (congestion)  in  any  one  organ,  it  has  a  great  ten- 
dency in  relieving  the  congestion  and  equalizing  the 
circulation.  In  extreme  prostration,  where  the  circula- 
tion is  very  feeble,  (especially  from  deficiency  of  blood,) 
it  then  requires  great  care  in  its  application.  "  When 
properly  modified  to  meet  the  actual  state  of  the  patient, 
it  may  be  said  to  be  the  most  soothing  application  that 
can  be  administered  to  the  external  sentient  surface." 
It  may  in  truth  be  compared  in  its  calming  effects  to  a 
soothing  poultice  placed  over  some  portion  of  the  body ; 
but  its  great  remedial  power  is  in  the  fact,  that  it  carries 
off  feverish  heat,  which  heat  is  employed  in  converting 
the  moisture  in  the  sheet  to  vapor,  which  is  produced 
by  the  heat  of  the  body  acting  on  the  moisture  of  the 
sheet,  forming  a  steam  bath  of  its  own  making.  As  a 
general  rule,  if  the  wet  sheet  should  be  applied  for  the 
purpose  of  reducing  irritation,  it  should  not  be  allowed 
to  remain  on  long  enough  to  induce  sweating.  It  is 
perfectly  applicable  where  there  is  morbid  irritation ;  a 
valuable  remedy  in  internal  and  external  inflammation, 
either  acute  or  chronic.  In  its  application,  when  your 
patient  is  laboring  under  a  high  fever,  it  may  be  neces- 
sary to  employ  a  blanket  or  two  for  covering.    It  can 


38 


VAPOR  BATH. 


be  applied  with  success  in  reducing  fever  and  inflamma- 
tion, counteracting  the  necessity  of  the  lancet ;  it  pro- 
duces no  actual  loss  of  strength  to  your  patient,  which 
is  quite  the  opposite  from  bleeding,  and  which  latter 
remedy  is  almost  always  followed  by  debility.  You  will 
frequently  find  cases  where  it  will  only  be  necessary  to 
apply  the  wet  sheet  over  the  body,  leaving  the  extremi- 
ties covered  with  a  blanket ;  for  there  are  persons  whose 
organic  energy  may  suffice  to  supply  the  surface  imme- 
diately over  the  vital  organs  with  caloric,  but  would 
fail  to  do  so  in  regard  to  the  extremities ;  these  are  the 
cases  where  you  are  required  to  exercise  judgment.  I 
have  never  had  a  case  requiring  its  application  over 
thirty-five  minutes,  but  have  frequently  suffered  them 
to  remain  an  hour,  followed  by  good  results.  Whatever 
may  be  the  principle  upon  which  the  wet  sheet  acts,  the 
southern  physician  will  find,  during  the  treatment  of 
most  of  our  diseases,  that  it  is  an  indispensable  remedy, 
and  one  on  which  he  can  safely  rely.  The  wet  sheet, 
in  a  great  variety  of  cases,  will  be  found  an  excellent 
substitute  for  the  vapor  bath. 

VAPOR  BATH. 

Water,  in  the  state  of  warm  vapor,  exerts  a  very 
powerful  and  depressing  influence  over  the  animal 
economy.  There  are  a  great  variety  of  modes  for  its 
application,  none  of  which  has  precedence  over  another, 
and  all  so  simple  that  any  one  is  capable  of  giving  it. 
I  am  fully  sensible  to  the  fact,  that  this  powerful  reme- 
dial agent  has  been  badly  abused,  and  carried  to  a  very 
ridiculous  extent,  under  the  old  application  of  "steam- 
mg"  Nevertheles,  when  properly  applied,  it  has  con- 
siderable claims  in  allaying  inflammatory  excitement, 


ALCOHOLIC  VAPOR  BATH. 


39 


and  in  violent  acute  disease  is  entitled  to  great  conside- 
ration. When  used,  the  viscid  matter,  which  will  be 
found  on  the  surface  of  the  body  after  its  application, 
should  be  washed  off  by  the  alkaline  bath,  and  rubbed 
dry  with  a  coarse  towel. 

ALCOHOLIC  VAPOR  BATH. 

This  bath  has  many  advantages  over  the  simple 
Vapor  bath ;  it  possesses  all  of  its  advantages,  accom- 
panied with  stimulating  effects  of  the  alcohol  which 
rises  in  vapor.  In  administering  this  bath  you  place 
the  patient  in  a  solid  bottomed  chair,  and  a  very  good 
mode  is  to  place  his  feet  in  a  warm  pedeluvian  bath, 
place  a  blanket  around  him,  and  let  him  drink  freely  of 
some  diaphoretic  tea.  Horse  mint  is  found  here  in  great 
abundance,  and  makes  a  good  ptisan.  Place  your  alcohol 
in  a  saucer  or  open  dish,  and  put  it  under  the  chair;  if 
the  vapor  becomes  too  warm,  you  will  open  the  blanket 
and  let  in  fresh  air.  When  your  patient  complains  of 
fatigue,  you  will  wrap  him  up  in  the  blanket,  and  place 
him  in  bed,  and  suffer  him  to  perspire  for  some  length 
of  time ;  you  will  then  rub  his  body  with  weak  lye,  and 
rub  dry  with  a  coarse  towel. 

I  flatter  myself  when  you  use  this  bath  for  the  pur- 
pose of  producing  perspiration,  that  you  will  afterwards 
frequently  have  recourse  to  it ;  it  does  not  have  that 
tendency  to  prostrate  which  follows  the  simple  vapor 
bath,  nor  is  your  patient  so  liable  to  take  cold  after- 
wards. I  have  had  great  success  with  this  remedy,  in 
relieving  rheumatic  and  other  inflammatory  fevers. 
This  remedy  I  suggested  some  years  ago  to  some  medi- 
cal friends,  who  entertain  for  it  an  opinion  equal  to  my 
own. 


40 


THE  ACID  BATH. 


THE  ACID  BATH. 

This  bath  may  be  made  by  adding  cider  vinegar  to 
water.  The  Acid  bathing  has  been  highly  extolled  in 
mercurial  cases.  The  vegetable  acids  are  far  more  pre- 
ferable in  the  great  variety  of  cases  to  those  of  a  mineral 
origin.  Circumstances  frequently  arise  which  may  indi- 
cate the  application  of  the  Sulphuric,  or  Nitro-muriatic 
dilutions,  in  which  cases  I  generally  use  about  2  5  of 
the  latter  to  a  quart  of  water,  and  sponge  the  body ;  a 
very  good  criterion  is  to  have  the  water  about  as  sour 
as  distilled  vinegar.  When  employed  in  this  manner 
it  is  a  useful  auxiliary  in  chronic  induration,  or  abscess 
of  the  liver,  in  cutaneous  diseases,  and  in  syphilitic  or 
mercurial  cachexia.  It  is  highly  extolled  in  the  pro- 
portions of  Nitro-muriatic  acid  Siii,  to  water  three  gal- 
lons, as  a  foot  bath.  When  employed  in  this  way,  Dr. 
Scott  says,  it  acts  like  a  charm  during  the  passage  of 
biliary  calculi  through  the  duct. 

THE  ALKALINE  BATH. 

There  are  a  great  variety  of  baths,  such  as  the  Arti- 
ficicial  Barege  bath,  Sulphuric-gelatinous  bath,  Subli- 
mate bath,  and  Artificial  Harrowgate  bath,  all  of  which 
baths  are  suited  generally  to  Prurigo,  (Itch)  and  other 
cutaneous  diseases,  and  all  of  which  are  too  well  known 
to  require  any  particular  notice;  but  of  all  the  medi- 
cated baths,  and  probably  the  most  simple,  I  conceive 
the  Alkaline  bath  the  most  important.  While  in  the 
act  of  perspiration  there  is  a  secretion  from  the  sub- 
cutaneous glands,  this  secretion  is  of  an  oleaginous  cha- 
racter; it  deposits  itself  upon  the  surface  of  the  cuticle, 
and  there  forms  in  many  instances  a  positive  mechani- 


EMOLLIENTS. 


41 


cal  obstruction  to  perspiration,  by  closing  the  mouths  of 
the  capillary  vessels.  And  an  author  of  some  celebrity 
asserts,  by  this  alone,  sometimes,  the  escape  of  a  large 
portion  of  fluid  from  the  system  is.  prevented,  and  the 
effete  matter  which  it  was  destined  to  carry  off  in  solu- 
tion is  thrown  back  upon  the  different  tissues,  and  acts 
upon  them  as  an  irritant,  or  rather  re-enters  as  a  poison. 
66  Now,  water,  cither  cold  or  warm,  will  not  affect  this  oily 
deposit,  but  an  alkaline  wash  combines  with  the  oleagi- 
nous substance,  and  thoroughly  cleanses  the  skin,  while 
at  the  same  time  it  is  a  gentle  tonic,  and  stimulates  the 
mouths  of  the  cutaneous  vessels,  which  is  highly  condu- 
cive to  the  healthy  performance  of  their  functions.  In 
my  own  practice  I  generally  use  the  wood  ashes,  by  pour- 
ing scalding  water  on  them- — saleratus  or  soda,  either  of 
which  is  a  good  substitute.  It  should  be  so  diluted  as 
not  to  produce  any  unpleasant  sensation  to  the  surface ; 
if  it  is  desirable  to  have  it  stimulating,  alcohol  or  capsi- 
cum can  be  added.  The  temperature  should  be  about 
luke  warm,  and  if  properly  persevered  in  it  will  pro- 
duce desquamation  from  the  skin,  and  allay  itching  in 
all  its  various  forms." 

EMOLLIENTS 

Have  a  very  great  tendency  to  diminish  the  vital 
tone  of  the  solid  tissues  of  the  body;  they  render  them 
more  flexible,  and  protect  the  surface  from  the  action 
of  acrid  matter;  their  action,  in  my  opinion,  is  directly 
on  the  part  to  which  they  are  applied,  and  indirectly 
through  the  medium  of  the  circulation.  I  frequently 
use  them  in  the  treatment  of  inflammation,  either 
general  or  local,  in  painful  ulcerations,  and  diseases  of 
the  urinary  organs.    The  ulmus  fulva  (elm  bark)  is 


42 


MEDICINES  AND  THEIR  USES. 


one  of  the  best  applications  of  this  character,  it  is 
impervious  to  air;  when  the  bark  is  ground  very  fine, 
it  is  a  good  addition  to  other  substances  to  make  them 
adhesive.  I  regard  flaxseed  as  the  next  best  application. 
In  a  case  of  anthrax  (malignant  carbuncle)  I  employed 
a  recipe  of  my  friend  Dr.  Ewing  of  this  city ;  I  esteem 
it  highly,  especially  where  there  is  a  tendency  to  morti- 
fication; it  is  flaxseed,  cinchona  bark,  and  charcoal;  the 
seeds  should  be  boiled  until  the  whole  becomes  a  soft 
pulp.  The  carrot  is  a  valuable  article  in  many  cases; 
it  should  be  grated  fresh,  with  boiling  water  poured  on. 
Of  the  non-medicinal  substances  employed  as  emollients, 
warm  water  is  decidedly  the  most  important,  and  the 
higher  the  temperature  at  which  it  can  be  applied, 
without  the  actual  production  of  pain,  the  greater  will 
be  its  emollient  power;  and  for  this  reason,  when 
applied  in  the  form  of  vapor,  it  will  be  found  produc- 
tive of  the  most  advantage. 


MEDICINES  AND  THEIR  USES, 

Under  this  head  I  have  determined  to  introduce  an 
article  for  the  benefit  of  the  profession,  devoted  entirely 
to  the  heading  of  this  subject,  deeming  it  one  of  the 
most  important  to  have  it  constantly  before  the  eye  of 
the  reader,  as  nothing  is  more  important  than  having  a 
proper  knowledge  of  the  modus  operandi  of  medicines. 
We  have  another  reason^  articles  of  this  character  are 
seldom  introduced  into  a  work  on  practice;  and  our 
object  is  to  make  this  work  one  of  practical  utility, 
saving  the  labor  of  referring  to  a  multiplicity  of  volumes 


MEDICINES  AND  THEIR  USES. 


43 


to  ascertain  some  particular  fact.  My  views  on  the 
medical  definition  of  terms,  and  their  peculiar  action  on 
the  human  system,  vary  from  the  large  mass  of  authors 
upon  this  subject;  my  opinion  of  their  action  is 
founded  entirely  from  experience,  and  as  s\ich  I  have  no 
hesitation  in  laying  them  before  you,  knowing  that 
what  action  I  attribute  to  them  can  be  strictly  relied 
upon. 

Antacids,  are  medicines  which  correct  acidity  of  the 
stomach  and  digestive  organs,  by  combining  chemically 
with  free  acid  existing  there,  and  neutralizing  it.  Their 
action  is  manifestly  only  temporary  and  palliative,  as 
they  do  not  correct  that  peculiar  state  of  the  digestive 
organs  which  favors  the  formation  of  acid;  and  their 
continued  use  produces  a  precisely  similar  disease  in  the 
alimentary  canal.  This  is  of  great  importance,  for  I 
have  often  seen  dj^spepsia  result  from  the  incautious 
use  of  alkaline  earths ;  they  are  strictly  chemical  reme- 
dies, and  when  taken  beyond  what  is  required  to  correct 
free  acicl,  they  become  irritants,  and  produce  morbid 
affections  of  the  stomach ;  to  use  them  as  a  palliative,  and 
employ  suitable  regimen  is,  in  my  opinion,  much  more 
preferable.  In  most  cases  abstinence,  and  a  proper  at- 
tention to  regimen,  will  soon  repair  the  evil ;  the  best 
antacids  are  prepared  chalk,  lime  water,  magnesia,  and 
bicarbonate  of  potash. 

Anthehnentics,  are  remedies  which  possess  the  property 
of  destroying  worms.  They  are  only  temporary  in  their 
action.  In  most  cases  worms  are  not  the  primary  cause 
of  disease ;  in  a  multitude  of  cases  anthelmentics  are 
given  for  weeks,  when  the  history  of  the  patient  proves 
that  he  has  only  suffered  from  the  suspicion  of  worms, 
while  his  malady  has  been  of  a  different  character.  The 


44 


MEDICINES  AND  THEIR  USES. 


truth  is,  no  certain  diagnosis  of  worms  other  than  their 
appearance  in  the  discharges  is  worthy  of  confidence, 
and  hence,  without  this  positive  proof,  remedies  for  their 
expulsion  are  of  equivocal  propriety.  It  need  scarcely  be 
said  that  medicines  which  are  styled  anthelmentics  are 
best  adapted  to  remove  them.  It  is  only  when  the  pre- 
sence of  worms  is  positively  ascertained  that  any  of  the 
specific  anthelmentics  are  at  all  adapted  to  the  case. 
Kousso  at  the  present  time  occupies  the  highest  position 
for  expelling  tape  worm.  I  have  never  administered 
the  article,  and  cannot  speak  of  my  own  knowledge,  but 
I  have  no  doubt  of  its  great  value;  from  the  experience 
of  some  gentlemen  in  whom  I  can  rely,  I  would  have 
no  hesitation  in  giving  it.  My  friend  Dr.  Holland,  of 
Galveston,  speaks  of  it  in  the  highest  terms.  A  very 
interesting  case  is  reported  in  the  "  Eclectic  Medical 
Journal,"  March  No.,  1852,  published  at  Cincinnati. 
Turpentine  was  well  thought  of  in  tape  worm,  but  with 
nvy  experience,  unjustly  so.  There  is  a  variety  used ; 
worm  seed,  garlic,  Carolina  pink  root,  tansy,  &c. 

Antispasmodics,  are  medicines  which  counteract  irre- 
gular or  inordinate  muscular  action — spasm.  This  de- 
ranged state  of  the  system  depends  on  so  many  causes, 
that  its  successful  treatment  will  very  frequently  depend 
on  the  employment  of  remedies  calculated  to  remove  the 
more  immediate  cause  by  which  the  spasmodic  affection 
is  produced.  There  are  certain  medicines  which  appear 
to  exert  a  direct  control  over  spasmodic  action.  Emetics 
are  among  our  most  useful  and  efficient  anti-spasmodics. 
The  lancet,  although  I  am  free  to  deprecate  its  use  gene- 
rally, nevertheless,  in  violent  cases  it  is  a  speedy  and 
effectual  anti-spasmodic.  The  patient  should  be  placed 
in  the  erect  position  so  as  to  favor  syncope.    It  should 


MEDICINES  AND  THEIR  USES. 


never  be  resorted  to  until  all  else  failed.  The  warm 
bath  is  a  valuable  auxiliary  in  severe  and  protracted 
spasm,  especially  when  the  bowels  are  involved  in  the 
disease.  There  are  a  variety  of  anti-spasmodics  :  assa- 
foetida,  musk,  castor,  rue,  amber,  valerian,  &c. 

Astringents,  are  those  substances  which  produce  con- 
traction and  condensation  when  they  come  in  contact 
with  living  matter.  Much  difference  of  opinion  exists 
as  to  the  modus  operandi  of  this  class  of  agents.  In 
cases  where  the  use  of  astringents  is  indicated,  it  will 
be  necessary  to  ascertain  the  cause  by  which  the  morbid 
discharge  is  produced,  as  it  frequently  arises  in  opposite 
states  of  the  system,  and,  therefore,  very  different  reme- 
dies will,  in  different  cases,  assume  the  character  of  an 
astringent.  Thus,  where  irritability  exists  opium  will 
often  prove  our  most  useful  remedy.  If  a  state  of  ple- 
thora of  the  vascular  system  exist,  the  pure  tincture  of 
aconite,  I  use  10  to  12  drops  to  1  oz.  of  water,  and  give 
a  tea  spoonful  every  ten  minutes ;  when  properly  ad- 
ministered, where  there  is  any  inflammatory  action  it 
will  control  the  circulation  more  readily  than  the  lancet, 
and  in  pneumonia  and  yellow  fever  it  is  indispensable. 
Nauseants  with  other  depletory  measures  will  be  indi- 
cated, or  if  the  discharge,  as  in  some  forms  of  diarrhoea, 
be  caused  by  acrid  or  acid  matter,  demulcents  and  anti- 
acids  must  be  employed.  Those  that  are  in  best  repute 
are,  sulphuric  acid,  alum,  catechu,  creasote,  blue  vitriol, 
green  vitriol,  gall  nuts,  logwood,  kino,  oak  bark,  borax, 
beanberry,  zinc,  &c. 

Cathartics,  are  those  medicines  which  quicken  or  in- 
crease the  alvine  discharge.  Cathartics  /lifFer  conside- 
rably in  their  action  upon  the  human  system,  and  hence, 
have  been  generally  divided  into  three  classes  :  1st 


46 


MEDICINES  AXD  THEIR  USES. 


Laxatives,  which  operate  so  mildly  as  to  produce  the 
evacuation  of  the  intestinal  contents  without  causing 
increased  secretion  or  stimulating  any  of  the .  neighbor- 
ing* viscera. 

2d.  Purgatives,  properly  so  called,  which,  besides 
remarkably  increasing  the  peristallic  motion  of  the  in- 
testines, occasion  increased  secretion  of  fluids  from  the 
exhalant  vessels,  and  also  extend  their  stimulant  effects 
to  the  system  in  general. 

3d.  Drastic  Cathartics,  which  operate  in  the  same 
manner  as  purgatives,  but  with  much  greater  energy. 
There  are  a  great  variety  in  use  ;  we  will  mention  some 
that  we  hold  in  high  estimation. 

The  Podophylline,  which  in  my  own  impression, 
exerts  as  ready  an  influence  as  calomel,  without  any  of 
the  constitutional  effects  which  is  frequently  the  result 
of  the  latter ;  it  is  a  remedy  which  is  inestimable,  and 
of  which  we  will  say  more  hereafter.  The  Septandrine 
is  another  very  valuable  remedy.  There  are  others  : 
gamboge,  colocynth,  aloes,  castor  oil,  &c. 

JJicqjJtoretics,  are  those  medicines  which  augment  the 
cutaneous  exhalations,  or  more  properly  speaking,  pro- 
duce a  termination  to  the  surface  by  copious  perspiration. 
We  frequently  find  obstructed  perspiration  associated 
with  fever,  and  those  remedies  should  be  selected  as 
will  act  by  relaxing  the  morbid  construction  of  the 
cutaneous  capillaries,  and  at  the  same  time  have  a  ten- 
dency to  lower  the  action  of  the  heart ;  warm,  tepid, 
diluent  drinks  assist  in  producing  perspiration.  The 
most  efficient  diaphoretics  are,  minclererus  spirit,  which 
is  a  solution  of  the  acetate  of  ammonia,  antimonial 
powder,  tartar  emetic,  common  burdock,  woody  night- 
shade, (or  bitter-sweet,)  Dovers  powder,  sarsaparilla, 


MEDICINES  AND  THEIR  USES. 


47 


sassafras,  sanguinaria,  (blood-root,)  Hydrastis  canad, 
(golden  seal,)  asclepia,  (pleurisy-root,)  xanthox,  (prickly 
ash,)  &c.  Beach's  sudorific  tincture  is  a  good  remedy  ; 
substitute  for  the  opium  cypripedium  pubescens  (ladies 
slipper)  8  oz.,  and  you  will  have  it  far  better. 

Diuretics,  are  medicines  which  augment  the  secretion 
and  promote  the  discharge  of  urine.  In  whatever 
manner  the  action  of  diuretics  is  produced,  their  gene- 
ral effect  is  to  diminish  the  watery  part  of  the  blood, 
and  by  this  means  promote  the  absorption  of  fluid 
effused  into  any  of  the  cavities  or  into  the  cellular  mem- 
brane. Much  obscurity,  however,  rests  upon  the  subject. 
They  are  too  often  prescribed  without  reference  to  the 
pathological  state  upon  which  the  disease  depends. 
Those  most  in  use  are,  sweet  spirits  of  nitre,  cantharides, 
common  juniper,  nitre,  squill,  oil  of  turpentine,  scalding 
water  on  honey  bees,  &c. ;  this  latter  is  very  good  to  re- 
lieve strangury. 

Emetics  are  those  medicines  which  are  used  for  the 
purpose  of  producing  vomiting;  the  number  employed 
with  this  intention  is  small.  In  selecting  a  remedy  of 
this  class,  we  should  be  guided  by  the  nature  of  the 
indication  which  is  to  be  fulfilled;  they  should  be  em- 
ployed with  great  caution  where  there  are  symptoms  of 
determination  of  blood  to  the  head,  in  consequence  of 
the  obstruction  of  the  circulation  which  is  occasioned 
during  the  act  of  vomiting ;  from  the  great  action  of  the 
abdominal  muscles  which  is  caused,  the  act  of  vomiting 
is  attended  with  great  risk  in  the  advanced  stages  of 
pregnancy,  in  hernia,  and  in  prolapsus  uteri.  An 
English  author,  I  find,  recommends  their  use  in  re- 
ducing hernia ;  I  should  pause  before  I  would  try  it,  but 
I  do  not  condemn  it.    There  are  but  few  remedies  of 


48 


MEDICINES  AND  THEIR  USES. 


this  class — tartar  emetic,  sulphate  copper,  ipecacuanha, 
squill,  sulphate  zinc,  an  acetous  mixture,  and  an  em?tic 
powder  of  my  own,  I  have  found  best  suited  to  this 
climate. 

To  make  the  Acetous  emetic,  take 
Sanguinaria, 
Lobelia  seeds, 

Ictodes  foetidae,  (skunks  cabbage  root.) 

Aa.  5  iss. 
Good  cider  vinegar  1  quart. 

These  articles  to  be  well  pulverized,  and  the  whole 
made  quite  moist  with  alcohol,  then  let  them  stand  24 
hours,  tightly  covered;  after  which  add  the  vinegar,  let 
it  stand  a  few  days,  then  strain  and  subject  the  drug  to 
pressure,  after  which  apply  a  gentle  heat  to  your  solu- 
tion, and  it  will  drive  off  the  alcohol. 

Dose,  1  dr.  every  ten  or  fifteen  minutes;  it  may  be 
increased  up  to  4  or  5.  To  be  taken  in  some  warm 
diaphoretic  tea.  Under  all  ordinary  circumstances,  you 
will  find  this  will  never  disappohit  your  expectations. 

The  emetic  powders  are  equal  portions  of  the  three 
first  ingredients,  in  acetous  mixture,  with  equal  parts  of 
pul.  ipecac.  Dose,  10  gr.  to  half  dr.,  given  in  warm 
infusion,  repeated  every  ten  or  fifteen  minutes. 

Emmenagogues  are  medicines  which  are  supposed  to 
be  capable  of  promoting  the  menstrual  discharge ;  there 
is  uncertainty  in  their  operations,  but  there  are  a  few 
which  are  employed  to  promote  the  menstrual  secretion, 
and  which  appear  to  act  solely  on  the  uterus.  These 
remedies  are  saffron,  which  is  a  valuable  remedy  to  re- 
move those  severe  lumbar  pains  which  so  frequently 
precede  or  accompany  menstruation,  ergot,  rue,  savin, 
sepia,  and  macrotin,  the  most  valuable  of  the  whole. 


MEDICIXE8  AXD  THEIR  USES. 


49 


Epispastics  are  substances  which  produce  redness,  in- 
flammation, or  vesication,  when  applied  to  the  skin. 
They  are  employed  in  the  practice  of  medicine  princi- 
pally with  the  intention  of  relieving  or  removing  the 
diseased  condition  of  some  internal  organ,  by  producing 
a  new  irritation,  or  determination  to  the  surface  of  the 
body,  or  some  remote  part.  Independently  of  this, 
however,  blisters,  which  are  the  most  important  medici- 
nal agents  in  this  division,  act  also  as  general  stimulants 
to  the  system,  and  as  such  are  frequently  used,  with 
much  benefit  in  the  advanced  stages  of  fevers,  and  in 
spasmodic  affections  arising  from  debility.  This  stimu- 
lant effect  of  blisters  should  be  borne  in  mind,  and,  con- 
sequently, their  application  should  be  avoided  in  the 
very  acute  stages  of  inflammatory  diseases,  until  the 
general  excitement  be  previously  subdued  by  antiphlo- 
gistic means.  A  distinguished  author  says : — "  Epispas- 
tics  are  generally  applied  as  near  the  seat  of  disease  as 
possible"  unless,  we  suppose,  when  the  intention  is  to 
produce  a  determination  to  some  remote  part  of  the 
body,  as  in  the  application  of  sinapisms  to  the  feet  in 
affections  of  the  head.  We  greatly  differ  in  one  portion 
of  the  paragraph,  and  that  we  have  italicised;  and  we 
do  contend  that  in  most  diseases  in  which  Epispastics 
are  necessary,  whatever  other  objects  may  be  contem- 
plated, one  of  the  first  indications  to  be  fulfilled  by 
these  agents  is  that  of  counter  irritation,  revulsion ;  and 
hence  we  do  conclude,  and  we  are  supported  by  the 
large  mass  of  scientific  men  in  the  United  States,  that 
blisters  'should  be  applied  remote  from  the  seat  of  disease. 
Most  of  the  colleges  teach  that  blisters  to  the  extremi- 
ties are  more  serviceable  in  inflammations  of  the  viscera 
of  either  the  great  cavities  of  the  body,  than  when  ap- 
4 


50 


MEDICINES  AND  THEIR  USES. 


plied  over  the  part  affected.  Especially  is  this  the  fact 
in  phrenitiSj  (inflammation  of  the  brain,)  for  though  in 
bad  cases  shaving  the  head  for  the  application  of  ice  is 
often  resorted  to,  yet  blisters,  instead  of  being  applied 
to  the  scalp,  thus  aggravating  the  disease,  are  judiciously 
placed  upon  the  thighs,  or  upon  the  spine.  Blisters  to 
children  should  be  applied  with  great  caution,  and  never 
suffered  to  remain  more  than  two  or  three  hours.  Those 
in  use  are,  tartar  emetic,  cantharides,  capsicum,  oil  of 
turpentine,  and  a  preparation  I  use,  the  irritating  plas- 
ter, which  we  will  treat  of  hereafter. 

Narcotics  may  be  denned  medicines  which  produce  a 
primary  stimulating  effect  on  the  nervous  and  vascular 
systems,  but  which  is  rapidly  followed  by  a  depression 
of  the  vital  powers.  In  large  doses,  the  stage  of  excite- 
ment is  very  short,  and  the  depression  of  vital  power 
almost  immediate.  There  are  numerous  remedies  used 
in  the  present  day,  nightshade,  Indian  hemp,  henbane, 
hops,  morphia,  opium,  poppy-heads,  thom-apple,  &c. 

S<  datives  are  medicines  which  depress  the  vital  pow- 
ers, without  inducing  any  previous  excitement;  they 
have  been  termed  contrarstimulants.  The  diseases  in 
which  sedatives  are  employed  are  those  of  over  excite- 
ment of  the  nervous  and  vascular  systems ;  some  of  the 
remedies,  for  instance,  aconite,  act  directly  on  the  ner- 
vous system.  They  are,  Prussic  acid,  one  drop  of  which 
has  been  known  to  produce  death,  peach  leaves,  hem- 
lock, creosote,  digitalis,  tobacco,  hydrocyanate  of  po- 
tassa,  &c. 

General  Stimulants  are  medicines  which,  in  their 
effects  upon  the  system,  are  closely  allied  to  tonics;  im- 
mediately after  their  administration,  a  feeling  of  tone  or 
increased  power  is  produced,  which  is  not  permanent, 


GENERAL  DIAGNOSIS. 


51 


but  is  generally  followed  by  depression  of  vital  powers. 
There  are  a  great  number  contained  in  this  class — 
nitrous  ether,  sulphuric  ether,  ammonia,  camphor,  &c. 

Tonics  are  substances,  the  continued  administration  of 
which  in  debilitated  and  relaxed  conditions  of  the  body 
imparts  strength  and  vigor,  without  producing  any  sud- 
den excitement.  There  is  no  class  of  remedial  agents 
which  requires  more  discrimination  in  their  administra- 
tion than  tonics;  nor  any,  the  injudicious  use  of  which 
more  frequently  produces  evil  consequences.  The  dis- 
eases in  which  they  are  employed  must  be  diminished 
power;  in  no  case  should  they  be  prescribed  when  there 
is  irritation  or  inflammation  of  the  digestive  organs,  or 
where  the  secretions  are  in  a  depraved  state. 


GENERAL  DIAGNOSIS. 

By  the  term,  diagnosis,  is  understood  the  i^eculiar 
faculty  of  distinguishing  one  disease  from  another. 
The  exact  appreciation  of  the  several  organic  alte- 
rations, chiefly  constitutes  diagnosis.  This  is  one  of  the 
most  important  branches  of  our  profession,  and  without 
doubt  one  of  the  most  difficult  The  number  of  those 
who  are  remarkable  in  diagnosis  is  extremely  small;  but 
in  the  practice  of  medicine,  how  important  is  a  correct 
diagnosis,  for  when  correct  in  that,  it  necessarily  tends 
to  a  rational  treatment.  In  order,  therefore,  to  form 
such  a  diagnosis,  one  that  can  be  relied  upon,  it  is  ne- 
cessary to  know  the  organs  and  functions  in  their  normal 
state ;  without  this  knowledge  we  cannot  appreciate  the 
changes  induced  by  disease.    Anatomy  and  physiology 


52 


GENERAL  DIAGNOSIS. 


are,  therefore,  preliminary  and  indispensable.  That 
great  and'  distinguished  author,  Liebig,  says: — "From 
what  a  different  point  of  view  should  we  contemplate 
the  abnormal,  or  diseased  conditions  of  the  human  body, 
if  Ave  were  first  thoroughly  acquainted  with  its  normal 
conditions — if  we  had  established  the  science  of  phy- 
siology upon  a  satisfactory  basis.  How  differently  would 
the  treatment  of  diseases  be  conducted,  if  we  had  per- 
fectly clear  notions  of  the  process  of  digestion,  assimila- 
tion and  excretion.  Without  just  views  of  force,  cause 
and  effect — without  a  clear  insight  into  the  very  essence 
of  natural  phenomena — without  a  solid  physiological 
education,  the  object  of  the  empiric  (those  who  know 
nothing  of  physiology  or  chemistry)  is  only  whether  a 
remedy,  in  any  given  case,  had  a  good  or  bad  effect. 
This  is  all  he  cares  about.  He  never  asks  why?  He 
never  inquires  into  the  cause  of  what  he  observes,  con- 
sequently is  it  to  be  wondered  at  that  men  should  be 
found  advocating  the  absurd  notions  of  Homeopathy  and 
the  like." 

The  study  of  mere  symptoms,  without  endeavoring  to 
ascertain  the  signification  of  these  symptoms,  has  at  all 
times  been  the  cause  of  producing  much  mischief  in  the 
treatment  of  diseases. 

It  is  quite  embarrassing  to  a  great  many,  the  exami- 
nation of  a  patient ;  this  only  arises  from  a  want  of  order 
and  method.  The  first  thing  is  to  examine  the  exterior, 
and  you  should  extend  the  examination  to  every  portion 
of  the  body.  I  have  a  case  in  point  which  will  demon- 
strate this  necessity.  I  was  called  in  consultation  with  a 
medical  gentleman  some  years  ago,  to  a  patient  who, 
some  six  or  eight  days  before  we  were  sent  for,  had  been 
thrown  from  his  horse.    My  friend  had  examined  the 


GENERAL  DIAGNOSIS. 


53 


patient  before  my  arrival ;  he  said  he  had  cough  and 
was  spitting  up  some  blood,  which  fact  he  viewed  as 
conclusive  that  his  lungs  were  the  seat  of  disease.  He 
had  acute  pain  in  the  side,  which  was  aggravated  by 
percussion  ;  pulse  full  and  strong,  some  fever,  and  con- 
siderable thirst ;  a  slight  crepitous-rale  was  observed  by 
the  aid  of  the  stethoscope.    My  friend's  diagnosis  was, 
that  this  man  had  pneumonia;   his  reasoning  was 
very  correct  from  principle,  but  if  he  had  examined 
the  exterior,  he  would  have  found,  as  I  did,  a  fracture 
of  the  ribs,  and  he  would  have  avoided  his  error.  I  hope 
this  one  illustration  will  pohit  out  the  necessity  for  a 
close  and  rigid  examination ;  every  symptom  should  be 
noted,  and  when  your  examination  is  over,  every  symp- 
tom should  be  studied  one  by  one  in  the  order  in  which 
they  presented  from  the  commencement  of  the  attack, 
to  the  period  when  the  patient  comes  under  your  charge. 
Having  ascertained  the  affected  organ,  your  next  and 
most  immediate  object  will  be  to  ascertain  the  nature  of 
the  disease  of  which  it  is  the  seat.    This  is  the  import- 
ant consideration,  and  the  difficulty  is  generally  occa- 
sioned by  the  want  of  anatomical  examinations  carefully 
conducted  at  different  periods  of  the  same  disease. 
When  you  have  ascertained  the  organ  which  is  the  seat 
of  disease,  the  prognosis  will  then  present  itself  for  your 
consideration,  and  in  arriving  at  a  just  prognosis,  you 
must  take  into  consideration  the  amount  of  fever  pre- 
sent, the  age,  the  idiosyncrasy  and  strength  of  your 
patient,  &c. 

The  pulse  is  an  important  consideration,  and  it  must 
be  attentively  and  deliberately  examined.  Great  atten- 
tention  must  be  paid  to  the  alimentary  canal ;  and 
recollect  that  a  slight  inflammatory  affection  at  the 


GENERAL  DIAGNOSIS. 


origin  of  a  spinal  nerve,  "  not  unfrequently  manifests 
itself  by  severe  and  protracted  pain  in  some  remote  part 
of  the  body ;  as  in  the  chest,  the  abdomen,  or  inferior 
extremities."  Another  important  consideration,  and 
which  you  will  frequently  find  in  this  climate,  is  that  in- 
flammation of  the  mucous  membrane  of  the  alimentary 
canal,  often  attends  in  a  variety  of  diseases  with  symp- 
toms so  slight  as  often  to  escape  the  notice  of  even  the 
most  acute  observers,  and  in  relation  to  diagnosis  on 
this  point,  especial  care  and  attention  must  be  paid  to 
the  examinations  of  the  symptoms,  and  especially  in 
regard  to  the  condition  of  the  tongue. 

It  will  be  well  to  consider  the  Diagnostic  Signs  which 
I  have  divided  into  those  exhibited  by  the  countenance ; 
the  attitude ;  the  nervous  system ;  the  digestive  organs ; 
the  circulatory  system ;  the  respiratory  organs ;  the  cir- 
cular surface ;  the  lymphatic  system  and  the  secretions. 

The  Countenance. — The  features  to  be  particularly 
examined  are  :  the  eyes,  the  nostrils,  the  lips,  the  brows. 

In  acute  simple  fever. — Eyes  and  face  red ;  respiration 
hurried ;  motions  of  the  nostrils  rapid.  In  acute  sympa- 
thetic fever  these  signs  are  absent.  (Hall.) 

Acute  ptom  from  inflammation  in  (lie  chest. — Features 
much  contracted ;  the  alee  nasi  acute  and  elevated,  the 
nostrils  contracted  and  expanded  by  the  acts  of  respira- 
tion, sometimes  a  vivid  flush  terminating  abruptly ;  heat 
inconsiderable. 

"  Dull  pain  in  the  chest. — Less  constriction  of  the  fea- 
tures ;  an  expression  of  great  anxiety ;  nostrils  widely 
dilated  before  inspiration. 

Effusion  into  the  Iv/ngs. — Countenance  livid,  anxious, 
turgid,  with  great  dyspnoea  (difficulty  of  breathing)  and 
dilation  of  the  nostrils  on  inspiration. 


GENERAL  DIAGNOSIS. 


55 


THE  PIITIIISICAL  COUNTENANCE. 

Acute  pain  in  the  abdominal  viscera. — Features  acute  ; 
forehead  wrinkled  ;  brows  knit ;  nostrils  drawn  up  and 
acute ;  under  lip  drawn  down  exposing  the  teeth." 

Organic  affections  of  the  7ieart. — (This  term  is  used  to 
distinguish  a  disease  of  structure  from  a  functional  dis- 
ease, thus,  when  the  liver  is  converted  into  a  hard, 
tuberculated,  or  other  structure,  it  is  called  an  organic 
disease.)  Countenance  anxious ;  vividly  flushed ;  pro- 
labia  (lips)  livid;  face  turgid,  oedematous,  (to  swell) 
cold.  "  In  hydrothorax  the  face  has  a  pale  livid  aspect." 

Soporose  affections. — (A  term  given  to  those  diseases 
that  produce  sleep.)  Flushes  livid,  tumid  ;  eyes  closed 
or  open  and  fixed ;  mouth  frequently  drawn  to  one  side. 

In  syncope. — (By  this  term  we  mean  that  the  respira- 
tion and  action  of  the  heart  either  cease  or  becomes 
much  weaker  than  usual,  arising  from  diminished  energy 
of  the  brain,  or  from  organic  affections  of  the  heart.) 
Pale,  shrunk,  cold  and  death-like. 

In  chlorosis. — (This  is  vulgarly  termed  "  green  sick- 
ness ;"  it  is  a  retention  or  suppression  of  the  menses.) 
Pale ;  puffy ;  a  peculiar  darkness  occupying  the  eyelids, 
and  sometimes  surrounding  the  mouth,  frequently  ulcers 
on  the  extremities. 

Chronic  irritation  of  the  boicels. — "  Puffy  countenance  ; 
upper  lip  pale  and  swollen ;  occurs  in  verminous  affec- 
tions and  scrofula. 

Attitude. — The  healthy  attitude;  advantages  to  be 
obtained  from  position  in  the  treatment  of  diseases. 
"  Preternatural  determination  to  a  part  diminished  by 
elevating  such  part ;"  the  head  to  be  raised  in  apoplexy, 
the  extremities  when  affected  with  inflammation,  the 


5G 


GENERAL  DIAGNOSIS. 


chest  or  body  in  affections  of  the '  thorax  and  the  legs, 
and  more  especially  with  an  old  ulcer. 

"  Supine  position,  with  tremulous  motion,  indicates 
much  muscular  debility." 

Fever  from  acute  local  inflammation,  is  not  attended 
with  muscular  prostration  unless  the  patient  has  been 
neglected,  and  if  death  should  ensue  from  neglect,  more 
muscular  power  in  the  latter  stage  will  be  evinced  than 
could  be  possibly  expected,  to  that  extent  at  times  as  to 
throw  the  attendant  from  off  his  guard. 

Characteristic  position  in  hydrotliorax. — By  this  term 
we  mean  dropsy  in  the  chest ;  in  severe  cases  inability  to 
lie  down ;  great  fatigue  with  the  least  exercise ;  when  in 
bed  the  patient  involuntarily  raises  his  head  and  shoulders 
high ;  sleep  interrupted ;  pulse  irregular  and  hard ;  thirst 
urgent;  urine  scanty  and  high  colored;  a  dry  cough 
present;  and  as  the  disease  advances  the  patient  is- un- 
able to  lie  down,  but  generally  rests  by  placing  his  fore- 
head upon  the  back  of  a  chair." 

"  Thoracic  effusion. — Distinguished  from  mere  organic 
disease  of  the  heart  and  lungs,  by  effects  of  firm  pressure 
on  the  epigastric  region  and  bodily  exertion.  Effects  of 
pressure  in  effusion;  general  agitation,  cough,  and  a 
sense  of  suffocation ;  not  so,  or  but  slightly,  in  organic 
affections  of  the  heart  and  lungs ;  bodily  exertion  excites 
more  dyspnoea  (difficulty  of  breathing)  and  distress  in 
effusion  than  in  organic  affections." 

66  Position  assumed  by  the  pa  tient,  in  abdominal  inflam- 
mation, with  acute  pain. — Fixed,  carefully  avoiding  all 
motion  and  pressure ;  generally  on  the  back,  knees  drawn 
up,  head  and  shoulders  a  little  elevated. 

Position  assumed  in  spasmodic  pains  of  the  abdomen. — 
Constantly  changing  posture,  desirous  of  pressure  on  the 


GENERAL  DIAGNOSIS. 


57 


abdomen,  recumbent  on  the  belly,  &c. ;  position  on  the 
back,  with  knees  constantly  elevated  in  the  latter  stage 
of  acute  diseases,  a  sign  of  retention  of  urine. 

The  Tongue. — Great  attention  and  close  observation 
must  be  paid  to  its  color,  its  surface,  its  shape,  and  the 
manner  in  which  it  is  protruded. 

A  u'Jdte  and  slightly  loaded  tongue,  indicates  inflam- 
mation or  high  irritation  of  the  mucous  membrane  of 
the  stomach  and  intestinal  canal.  Tongue  seldom  much 
affected  in  acute  symptomatic  fevers,  from  wounds  or 
external  inflammation. 

A  pale  and  tumid  tongue,  with  large  papillae,  indica- 
tive of  gastric  debility — met  with  in  chlorosis. 

A  contracted  and  pointed  tongue,  frequently  an  at- 
tendant on  cerebral  or  meningeal  inflammation. 

A  yellow  and  bitter  tongue,  indicative  of  biliary  de- 
rangement. 

Florid  papillae  protruding  through  a  layer  of  white 
fur,  characteristic  of  scarlatina. 

A  flabby  and  dilated  tongue  occurs  in  congestive 
states  of  fever. 

A  white,  and  sometimes  brown  tongue,  dry  and  clam- 
my, indicative  of  remittent  fever. 

MORBID  STATES  OF  THE  NERVOUS  SYSTEM. 

Disturbed  Sleep. — Coma  always  denotes  oppression  of 
the  brain. 

Sudden  Start  in  gs  in  Sleep. — Intestinal  irritation  from 
worms,  or  spasmodic  pains  of  the  abdomen. 

Hurried  Wakings,  with  a  horrific  sense  of  suffocation, 
a  sign  of  organic  disease  of  the  heart. 

Pain  may  arise  from  inflammation,  from  spasm,  and 


58 


GENERAL  DIAGNOSIS. 


from  nervous  irritation.  They  have  each  their  peculiar 
character. 

Inflammatory  Pain. — Tenderness  of  part,  increased 
by  pressure;  throbbing  or  burning  continuous,  and  at- 
tended by  febrile  excitement. 

Spasmodic  Pain. — Paroxysmal,  not  throbbing  nor 
burning;  relieved  by  pressure,  and  seldom  attended 
with  fever. 

Neuralgic  Pain. — By  this  we  mean  pain  in  a  nerve; 
is  transient  but  violent,  no  swelling,  no  heat,  and  easily 
renewed  by  touch. 

Alimentary  Canal. — Appearances  of  the  alvine  dis- 
charges— clay-colored  faeces  indicate  deficiency  of  bile, 
met  with  in  jaundice  and  hepatitis.  Watery  and  reddish 
stools,,  like  the  washings  of  flesh ;  the  same  mucous  and 
bloody  stools  also. 

Kespiratory  Organs. — The  function  of  the  lungs 
differ  from  the  other  organs  in  this  circumstance — it  is 
performed  with  a  noise ; — in  sound  physiology  it  must 
be  expected  that  when  the  function  of  these  parts  are 
disturbed,  the  physiological  sound  will  become  patholo- 
gical; that  the  sound  will  be  altered,  and  such  is  the 
fact.  Accelerated  respiration  is  always  attended  with 
frequency  of  the  pulse;  slow,  irregular,  and  stertorous 
breathing  attends  a  high  degree  of  cerebral  compression. 
The  peculiar  respiration  in  hydrothorax,  is  that  the 
inspiration  is  quick  and  with  great  effort,  and  that  the 
respiration  is  slower  and  without  effort.  The  effects  of 
corporeal  exertion  on  respiration  produces  great  dys- 
pnoea (difficulty  of  breathing)  in  hydrothorax,  and  still 
more  in  organic  cardiac  affections. 

Wheezing  Respiration. — In  asthma,  cynanche  trache- 
alis,  (croup,)  hurried,  panting  and  heaving  respiration, 


GENERAL  DIAGNOSIS. 


59 


with  sighing,  often  attends  intestinal  irritation  and 
exhaustion  from  haemorrhage.  ' 

Cough. — When  the  efforts  of  coughing  are  anxiously 
repressed,  there  is  probably  inflammation  in  the  chest 
or  abdomen. 

Spasmodic  Cough. — In  pertussis  (whooping-cough) 
sometimes  from  irritation  of  the  stomach. 

Sputa. — We  have  it  of  thin  mucus,  sometimes  thick 
and  opaque,  of  a  whitish  color;  sometimes  mixed  with 
purulent  matter,  as  in  chronic  bronchitis. 

Cuticular  Surface. — Its  temperature,  its  color,  its 
state  of  dryness  or  moisture,  its  fullness  or  constriction, 
its  roughness  or  smoothness. 

A  yellowish  tinge  indicates  biliary  derangement;  not, 
however,  to  be  confounded  with  that  peculiar  sallow- 
ness  which  occur  in  cancer  and  chlorosis..  Permanently 
dry  and  husky  skin  indicates  torpor  or  chronic  disease 
of  the  liver.  • 

Urine. — Small  in  quantity  and  red,  in  inflammatory 
affections;  copious  and  limpid  in  nervous  diseases. 

Bilious  Urine. — The  various  sediments — lithates,  phos- 
phates; the  former  are  red  or  purple,  the  latter  white 
or  pale  yellow. 

Violent  Inflammation  of  the  Brain. — The  pupils  are 
dilated  or  much  contracted,  the  eye  generally  red;  if 
there  should  be  lesion,  you  have  squinting,  and  the  eye 
lids  become  paralyzed. 

Inflammation  in  the  Abdomen,  to  be  distinguished  from 
spasmodic  pains  of  the  stomach  and  bowels.  In  inflam- 
mation, the  patient  lies  on  his  back,  knees  drawn  up, 
head  and  shoulders  raised,  and  resists  all  pressure  on 
the  abdomen.    In  spasmodic  pains  or  colic  on  the  con- 

% 


GO 


GENERAL  DIAGNOSIS. 


trary,  patient  writhes  and  changes  posture  frequently, 
and  rather  desires  pressure  over  the  abdominal  region. 

Inflammed  or  highly  irritated  condition  of  the  Mucous 
Membreme  of  the  Alimentary  Canal. — There  is  a  clean 
and  red  appearance  of  the  tongue,  sometimes  rough.  In 
chronic  gastritis  and  enteritis,  the  tongue  invariably  ex- 
hibits a  dark  red  appearance;  sometimes  it  is  granulated. 

Dyspepsia. — The  tongue  loaded,  mouth  clammy,  taste 
bitter,  breath  fetid.  The  tongue  does  not  differ  mate- 
rially from  that  which  is  presented  in  chlorosis,  except 
that  the  latter  is  pale  instead  of  red,  and  indicates  in 
addition  to  gastric  derangement,  a  defect  in  the  process 
of  sanguification. 

Synochms  Fever. — One  of  the  first  symptoms  is  that  of 
a  tremulous  tongue;  as  the  disease  progresses,  it  turns 
a  dark  brown. 

"  Wakefulness  is  indicative  of  great  cerebral  irritation 
o#  exhaustion.  It  is  particularly  apt  to  occur  from 
sympathetic  excitement  of  the  brain,  depending  on  in- 
testinal irritation,  and  exhaustion  from  loss  of  blood." 
When  morbid  wakefulness  depends  on  these  causes,  it 
is  almost  invariably  attended  with  great  restlessness  or 
jactitation,  (to  toss  about,)  a  distressing  feeling  of  anxie- 
ty in  the  region  of  the  heart,  a  constant  disposition  to 
draw  long  breaths,  with  a  pale  and  contracted  counte- 
nance. Sudden  starting  during  sleep  is  generally  con- 
nected with  latent  indigestion.  Similar  symptoms  occur 
in  organic  affections  of  the  heart.  I  was  called  in  con- 
sultation to  a  patient,  with  my  friend  Dr.  McCrayen, 
laboring  under  the  above  symptoms,  and  we  were  an- 
noyed to  arrive  at  a  just  diagnosis,  whether  it  was  cere- 
bral irritation  or  an  organic  affection  of  the  heart. 

Morbid  Sensation. — Neuralgic  pain  differs  widely  from 


GENERAL  DIAGNOSIS. 


61 


inflammatory  or  spasmodic  pain ;  it  is  transient  and  ex- 
tremely violent  in  its  paroxysms.  It  passes  with  tele- 
graphic rapidity  along  the  ramifications  of  the  affected 
nerve. 

In  regard  to  pain  I  wish  to  impress  upon  your  mind 
a  very  important  fact — there  is  a  variety  of  pain,  and 
we  frequently  obtain  important  diagnostic  indications 
from  the  different  character  it  assumes  in  each  structure 
of  the  animal  system.  For  instance  in  the  mucous 
membranes,  inflammation  is  accompanied  with  a  burn- 
ing or  stinging  pain,  and  generally  not  very  violent; 
and  again  in  the  serous  membranes  the  pain  is  sharp 
and  lancinating,  and  remarkably  acute;  in  the  fibrous 
tissues  it  is  dull,  aching  and  boring;  in  the  nerves  it  is 
rapid,  darting  and  excruciating;  in  the  cellular  struc- 
tures it  is  throbbing,  heavy  and  dull.  Consequently  we 
find  the  pain  experienced  from  inflammation  of  the 
pleura  acute,  piercing  and  severe;  whilst  that  from  in- 
flammation of  the  substance  of  the  lungs,  is  dull,  j^ress- 
ing  and  inconsiderable  hi  violence.  Another  important 
fact,  that  in  hip  disease,  pain  in  the  knee  is  felt  for  a 
considerable  time  before  any  unpleasant  sensations  are 
complained  of  hi  the  hip. 

Organic  Disease  of  the  Heart  is  accompanied  with 
laborious  breathing  on  muscular  exertion,  oi\  strong 
mental  excitement.  (We  have  already  given  the  symp- 
toms of  wakefulness  and  j actuation  under  this  head.) 
A  cold  clammy  state  of  the  extremities,  nose  and  cheeks, 
with  heat  in  the  rectum  and  under  the  tongue,  and  a 
puffy  swelling  under  the  eyes,  are  also  indicative  of  or- 
ganic affection.— (Eberlee.) 

Coughing. — We  alluded  to  this  before,  and  it  is  a 
symptom  which  requires  close  observation,  and  like  pain 

it 


G2 


GENERAL  DIAGNOSIS. 


there  is  quite  a  variety  of  cough ;  patients  affected  with 
inflammation  of  the  pluera,  lungs,  or  peritoneum,  always 
endeavor  to  repress  the  cough  as  much  as  possible.  The 
cough  attending  acute  inflammation  of  the  mucous 
membrane  of  the  bronchia  has  a  much  duller  sound, 
and  a  rattling  in  the  chest;  these  you  seldom  find  in 
acute  inflammation  of  the  pluera;  this  only  applies  to 
the  early  period  of  these  affections.  In  phthisis  laryn- 
gea  the  cough  comes  on  in  violent  and  spasmodic  pa- 
roxysms, particularly  in  the  morning  on  rising  from 
bed,  whilst  in  phthisis  pulmonalis  (consumption)  the 
cough  is  much  less  sudden  and  violent,  and  destitute  of 
the  spasmodic  character  of  the  former. 

The  character  and  appearance  of  the  matter  expec- 
torated afford  important  diagnostic  indications;  and  a 
variety  of  tests  have  been  proposed,  and  with  just  claims 
to  confidence.  The  muriate  of  ammonia  coagulates 
pus,  but  it  has  no  effect  upon  mucus.  Heat  coagulates 
mucus,  but  not  pus. 

A  purple  or  bluish  color  of  the  skin,  if  not  the  result 
of  cold,  indicates  deficient  decarbonization  of  the  blood 
in  the  lungs,  seen  in  a  striking  manner  in  cholera. 

Urine. — This  secretion  affords  frequently  valuable 
diagnostic  signs, — in  inflammatory  affections  it  is  red 
and  in  small  quantity ;  in  nervous  and  hysterical  affec- 
tions it  is  copious  and  limpid ;  in  biliary  derangements 
almost  invariably  thiged  with  bile. 


GENERAL  PROGNOSIS. 


G3 


GENERAL  PROGNOSIS. 

Pi'ognosis  is  that  peculiar  prescience  or  fore-knowledge 
of  the  course  and  termination  of  diseases.  It  is  essential 
and  frequently  necessary  to  predict  how  a  disease  will 
terminate,  and  a  correct  knowledge  of  prognosis  is  a  sure 
source  of  credit  and  reputation.    To  form  an  accurate 
opinion  on  this  head  is,  however,  one  thing — to  divulge 
it,  another.    There  is  great  risk  of  losing  instead  of 
gaining  credit,  by  strong  statements  and  confident  pre- 
dictions of  the  death  or  recovery  of  a  patient.    If  your 
prognosis  is  unfavorable,  the  friends  naturally  conclude 
that  you  are  not  infallible,  and  they  will  grasp  at  any 
quack  who  makes  pretensions  to  cure  such  diseases ;  this 
is  not  always  so,  but  in  a  large  majority  of  cases  it  is. 
You  will  frequently  see  Doctors  who  affirm  they  cure 
cases  in  advanced  phthisis  (consumption)  ;  if  they  cure 
anything,  it  is  generally  chronic  inflammation,  with  puri- 
form  discharge  of  the  mucous  membrane  of  the  bronchi. 
The  profession  as  well  as  the  public  should  view  with 
suspicion  such  statements,  let  them  come  from  whatever 
quarter  they  may.    Certain  symptoms  may  disclose  to 
us  what  the  malady  is,  and  where  it  is  situated ;  other 
symptoms  teach  whether  our  patient  is  likely  to  survive 
or  not.  In  a  work  of  this  character,  devoted  exclusively 
to  practice,  we  will  have  to  condense  many  articles,  and 
especially  the  one  under  this  head ;  but  we  conceive  the 
subject  of  sufficient  importance  to  give  the  most  promi- 
nent characteristics  in  regard  to  prognosis,  of  our  own 
observation,  and  take  pleasure  in  referring  the  medical 
reader  to  Watson's  practice  of  physic,  by  Condie,  to  a 
very  elaborate  and  scientific  article  upon  this  subject. 


64 


GENERAL  PROGNOSIS. 


The  mere  fact  of  a  single  symptom  cannot  be  sufficient 
to  the  scientific  practitioner  to  base  a  positive  prognosis ; 
all  the  causes,  as  well  as  the  general  phenomena,  the 
habits  and  temperament  of  the  patient,  must  be  care- 
fully taken  into  consideration. 

Alterations  in  tlie  face. — A  great  many  important  signs 
are  discernable  from  this  portion  of  the  human  system. 
If  the  heart's  action  is  great,  we  see  it  in  the  face.  If 
there  be  congestion  in  the  body,  we  have  coldness  of  the 
face,  especially  the  cheeks,  nose  and  lip.  If  hectic  fever, 
we  soon  perceive  the  redness  of  the  cheek.  If  we  have 
jaundice,  we  soon  discover  it  in  the  face,  especially  the 
eyes.  Two  of  the  chief  mark's  of  scrofula  are  shown  in 
the  face — the  dilated  pupil  and  the  tumid  under  lip. 

The  countenance  is  a  sure  indication  to  the  state  of 
your  patient,  and  especially  in  cases  of  a  serious  and 
dangerous  character.  We  frequently  find  a  countenance 
that  strikes  us  forcibly,  and  we  view  it  as  the  harbinger 
of  death,  that  is  almost  indescribable ;  it  is  termed  the 
Hippocratic  countenance,  and  described  by  some  authors 
viz  :  "  nose  pointed,  eyes  sunk,  temples  hollow,  ears  cold 
and  shrivelled,  the  lobes  everted,  skin  on  the  forehead 
hard,  tense  and  dry,  countenance  pale,  livid  or  leaden." 
We  are  satisfied  immediately  from  the  countenance, 
whether  the  patient  is  in  pain  or  not,  if  he  has  colic,  it 
is  depicted  on  his  countenance,  and  to  all  the  numerous 
mental  diseases,  we  need  not  capitulate,  as  the  counte- 
nance affords  the  best  indication  of  their  character. 

The  attitude. — We  learn  from  observation  considerable 
in  regard  to  position.  It  is  an  alarming  symptom  to 
discover  your  patient  first  on  his  side  and  gradually  get- 
ting on  his  back,  until  he  is  in  a  supine  position ;  unfa- 
vorable, when  we  have  great  restlessness  of  the  whole 


GENERAL  PROGNOSIS. 


65 


body ;  it  betokens  great  prostration,  when  we  find  the 
patient  upon  his  back,  his  mouth  and  pupils  dilated,  and 
still  worse  when  we  find  he  has  involuntary  discharges. 
Insensibility,  with  mouth  closed  and  eyes  fixed,  a  sure 
sign  of  convulsions.  A  great  desire  to  sit  up,  with  dif- 
ficulty of  breathing,  or  laying  upon  the  back  with  the 
knees  drawn  up,  and  one  leg  flexed  over  the  other,  in 
pneumonic  diseases,  almost  certainly  fatal,  but  still  more 
so  when  attended  with  a  good  pulse ;  reaching  into  the 
air,  picking  the  bed  clothes,  visceral  inflammations, 
tumefaction  of  the  abdomen,  are  alarming  signs.  "Ster- 
torous breathing,  attended  with  a  rattling  in  the  upper 
part  of  the  chest,  is  highly  dangerous.  Short  and  very 
accelerated  breathing,  always  a  bad  sign ;  hiccough,  in 
the  advanced  stages  of  fevers,  indicates  great  danger." 
Constant  wakefulness,  or  great  degree  of  somnolency,  is 
quite  unfavorable ;  great  pain  in  the  head,  with  a  puffed, 
red  countenance,  is  indicative  of  much  danger.  "  Un- 
equal distribution  of  temperature — a  sensation  of  cold 
externally,  and  of  heat  internally,  are  bad  signs, — still 
more  unfavorable  when  a  sense  of  burning  heat  on  the 
surface  is  attended  by  a  feeling  of  cold  internally. 

The  Hand. — In  this  portion  of  the  system,  many 
symptoms  appear  that  are  positive  signs  for  good  or  bad ; 
it  shows  the  first  fall  of  the  temperature  of  the  body ; 
the  cold  clammy  perspiration  is  soon  discovered  here, 
difficulty  of  breathing  produces  a  purple  hue  of  the  nails, 
and,  in  fact,  its  heat,  its  firmness  or  softness,  are  all  sig- 
nificant. 

The  Excretions. — They  consist  of  blood,  bile,  secretions 
from  the  alimentary  canal,  of  urine,  of  perspiration,  of 
saliva  and  of  semen ;  and  with  respect  to  them,  the  sight 
and  smell  gives  us  most  information.    The  urine  is  fre- 
5 


66 


GENERAL  PROGNOSIS. 


qucntly  examined  by  taste,  to  ascertain  whether  it  con- 
tains acid,  or  is  neutral,  or  alkaline ;  you  can  detect  by 
weight  whether  it  con  tains  any  saccharine  matter,  and 
this  is  of  great  importance,  especially  in  diabetes,  which 
is  to  pass  large  quantities  of  urine  daily.  Dr.  Prout 
reports  some  cases  where  he  found  the  urine  perfectly 
black;  this,  of  course,  is  highly  dangerous.  Suppres- 
sion of  urine,  in  protracted  and  violent  cases  of  fever, 
highly  dangerous. 

Alvine  Evacuations. — They  are  various  in  their  cha- 
racters ;  we  sometimes  find  them  black  or  a  little  red, 
and  sometimes  bloody ;  this  latter,  when  not  accompa- 
nied with  inflammation,  is  easily  arrested  by  small 
portions  of  the  oil  of  turpentine,  or  sulphuric  acid  and 
tinct.  opii,  or  by  the  white  of  an  egg  and  opium.  A 
liquid,  frothy,  green  discharge,  resembling  the  washings 
of  flesh,  with  swelling  of  the  abdomen,  highly  dangerous. 
The  expulsion  of  urine  a  good  sign.  (Rush.)  Bloody 
stools,  in  the  latter  stages  of  bilious  or  malignant  fever, 
highly  unfavorable ;  less  dangerous  in  strictly  inflamma- 
tory fevers.  Involuntary  discharges  always  indicate 
great  danger. 

Perspiration. — Copious  perspiration  about  the  face, 
especially  if  cold  and  clammy,  indicate  great  prostration ; 
partial  sweating  a  bad  sign ;  profuse  clammy  perspira- 
tion, attended  with  a  small  and  frequent  pulse,  is  sure 
to  be  fatal.  There  is  an  offensive  perspiration  which 
exudes  from  the  feet  highly  unpleasant,  and  for  which 
I  know  no  remedy ;  a  pedeluvium  strongly  impregnated 
with  salt,  and  an  astringent  applied,  after  wiping  dry, 
might  be  of  benefit. 

Vomiting. — It  is  common  for  the  mouth  to  become 
filled  with  a  fluid ;  this  fluid  generally  contains  a  large 


GENERAL  PROGNOSIS. 


G7 


quantity  of  muriatic  acid.  We  also  find  persons  vomit- 
ing up  their  food,  and  it  is  exceedingly  sour  and  acid ; 
these  are  the  results  of  indigestion.  Black  discharges 
from  the  stomach,  especially  in  yellow  fever,  highly 
dangerous ;  a  rumbling  noise  in  the  stomach  when  fluids 
are  swallowed  is  a  bad  sign ;  very  frequent  vomiting, 
with  tenderness  over  the  region  of  the  stomach,  in  fevers, 
quite  unfavorable. 

Fetid  Breath. — There  is  frequently  bad  breath;  it  is 
sometimes  sour,  and  at  times  as  foecal  matter.  The  most 
disagreeable  breath  arises  from  depraved  secretions  of 
the  tonsils  ;  this  latter  is  particularly  offensive.  With 
foul  breath  generally,  we  have  eructations ;  these  may 
be  simple  or  fetid ;  those  which  are  inodorous  are  expe- 
rienced when  the  stomach  is  empty.  The  fetid  eructa- 
tions arise  when  the  stomach  is  full  and  the  contents'* 
undergoing  a  certain  degree  of  fermentation.  Persons 
who  are  subject  to  being  costive  have  fetid  eructations, 
which  are  removed  when  the  bowels  are  kept  in  a  solu- 
ble condition. 

The  Tongue. — No  inflammation  can  exist  in  the  sj^stem 
without  the  tongue  becoming  white.  In  delirium  tre- 
mens it  is  always  covered  with  a  white  mucus ;  when 
covered  with  brown  or  black  crust  with  cracks  in  it, 
dangerous ;  black  and  dry,  with  sorcles  adhering  to  the 
teeth,  highly  dangerous.  A  dark  brown,  hard  and 
shrivelled  tongue,  almost  certainly  fatal;  secretion  of 
saliva  a  good  sign.  Keeping  the  tongue  between  the 
teeth  without  retracting  it  is  a  bad  sign.  A  red,  smooth 
and  shining  tongue,  dry  around  the  edges,  indicates  con- 
siderable danger,  it  is  a  sign  of  gastric  inflammation. 
Total  absence  of  thirst,  with  a  dry  and  rough  tongue,  is 
a  bad  symptom.    There  is  a  variety  of  other  appear- 


G8 


GENERAL  PROGNOSIS. 


ances  that  would  demand  attention  in  forming  an 
opinion  as  to  the  probable  event  of  diseases. 

Critical  days. — The  ancients  imagined  that  a  crisis 
occurred  particularly  on  certain  days  at  which  promi- 
nent changes  are  wont  to  occur.  We  have  yet  some 
modern  authors  who  contend  for  the  same.  It  is  a 
vulgar  notion  that  prevailed  amongst  ancient  physicians, 
and  they  have  come  down  to  us  and  still  "  linger  among 
the  vulgar."  Some  persons  say  they  observe  these 
things ;  but  I  cannot  say  that  I  have  ever  noticed  the 
disease  to  terminate  on  one  day  in  preference  to  another. 
The  reason  we  do  not  observe  what  the  ancients  did,  is 
said  to  be,  that  we  are  more  active  in  practice  than  they 
were.  We  do  not  let  nature  take  her  course,  but  en- 
deavor to  knock  a  morbid  process  on  the  head ;  and  we 
save  five  patients  where  they  saved  one.  We  allow 
diseases  to  run  on  a  much  shorter  period  than  they 
were  accustomed  to  do ;  and  some  ascribe  the  want  of 
critical  days  to  our  active  practice.  To  show  the  inef- 
ficacy  of  the  practice  of  the  ancients,  Broussais  asserts, 
that  an  account  of  thirty  cases  of  acute  diseases  is  men- 
tioned, in  which  eighteen  patients  died,  and  the  other 
twelve  suffered  much  afterwards.  It  must  have  been  bad 
practice  to  lose  eighteen  acute  cases  out  of  thirty.  Sir  Gil- 
bert Blane  says,  out  of  forty-two  cases  of  acute  diseases, 
thirty-seven  of  which  were  continued  fever  without  local 
affection,  and  five  with  local  affection,  of  these  twenty- 
five  died,  twenty-one  of  the  thirty-seven,  and  four  out  of 
the  five.  If  nature  had  an  inclination  to  perform  her 
cures  on  certain  days,  she  had  there  a  fine  opportunity ; 
but  at  the  present  day  we  so  interrupt  her  course  that  I 
have  never  observed  critical  days. 

Critical  Haemorrhages. — This  is  always  the  result  of 


GENERAL  PROGNOSIS. 


69 


increased  arterial  action,  and  generally  beneficial,  partly 
from  the  loss  of  blood,  and  again  by  the  new  arterial 
excitement  by  which  they  are  attended ;  these  crisises 
are  generally  confined  to  inflammatory  fevers,  they  occur 
sometimes  in  typhus;  epistaxis  (or  haemorrhage  from 
the  nose)  is  the  most  common,  always  preceded  by  one 
or  more  of  the  following  symptoms — flushed  face,  red 
and  suffused  eyes,  sneezing  and  ringing  in  the  ears. 

Critical  Sweat. — This  is  an  important  crisis,  and  when 
favorable,  it  is  general,  over  the  whole  body,  attended 
with  a  warm  skin;  it  is  indicated  by  a  soft  full  pulse, 
an  extraordinary  degree  of  stinging  or  itching  (most 
commonly  the  latter)  sensation  on  the  surface,  the  cuti- 
cle turns  red,  and  the  patient  soon  gets  restless. 

Excess  of  Urine. — There  is  frequently  an  excess  in 
various  diseases.  In  asthma  there  is  frequently  a  large 
quantity  of  pale  urine  made ;  in  hysterical  and  dyspep- 
tic persons,  this  is  frequently  the  case;  fright  also  pro- 
duces it.  But  as  a  critical  discharge  it  must  be  copious, 
and  some  contend  the  morning  urine  is  best  for  inspec- 
tion ;  it  will  exhibit  at  first  a  cloud,  floating  in  the  up- 
per part  of  the  vessel,  and  finally  a  sediment;  it  will 
be  attended  with  a  soft,  moist  skin,  and  a  frequent  in- 
clination to  urinate. 

Critical  Alvine  Discharges.  —  Very  frequently  take 
place  in  bilious  fevers;  they  are  generally  copious,  and 
indicated  by  a  peculiar  trembling  of  the  under  lip,  a 
full  active  pulse,  pain  in  the  bowels,  discharge  of  wind, 
moist  tongue,  and  scarcity  of  urine. 

Auscultation  and  Percussion. — We  have  concluded  to 
bring  this  subject  under  this  head,  and  to  give  our  tes- 
timony to  the  truth  of  Lsennec's  discoveries.  We  know 
by  the  large  mass  of  physicians  who  have  passed  the 


70 


GENERAL  PROGNOSIS. 


age  of  forty,  that  it  is  generally  viewed  as  chimerical, 
and  there  seems  to  be  an  innateness  in  the  human  mind 
to  reject  the  lights  of  science  in  regard  to  new  discove- 
ries. After  this  period  they  seem  to  rest  satisfied  with 
imperfect  information,  when  application  would  give  us 
more;  to  admire  ignorance,  when  knowledge  is  within 
our  reach,  they  examine  discoveries  with  the  hope  of 
finding  it  deceptious;  they  are  unwilling  to  learn  be- 
cause they  are  no  longer  in  statu  pupillari,  (hi  the  rank  of 
pupils.)  So  high  in  their  own  estimation  as  to  feel  it  a 
disgrace  to  be  taught  by  others,  they  are  so  unphi- 
losophical  as  to  have  an  hostile  opinion  upon  mat- 
ters, which  observation  must  decide;  and  guilty  of  la- 
menting the  inconsistency  of  our  art,  while  they  are  too 
indolent  to  investigate  a  method  which  professes  to  re- 
move much  of  its  uncertainty.  These  facts  were  well 
demonstrated  when  the  immortal  Harvey  discovered 
the  circulation  of  the  blood,  and  it  is  asserted  upon 
the  best  authority,  that  not  a  single  physician  could  be 
found  over  the  age  of  forty  in  England,  that  would  give 
in  to  the  discovery,  nor  did  they  until  the  latest  hour 
of  their  death.  Nor  would  the  aged  plrysicians  of  Mont- 
pelier  acknowledge  the  lacteal  vessels,  so  wedded  were 
they  to  ancient  opinions ;  this  too  frequently  is  the  case, 
but  it  is  for  the  young  physician  to  investigate,  and  he 
will  have  a  store  of  knowledge  of  great  importance, 
which  the  mass  of  aged  physicians  reject.  The  lan- 
guage of  a  distinguished  author  is  here  appropriate : — 
"Far  be  it  from  the  defenders  of  auscultation  and  per- 
cussion to  assert,  that  the  diagnosis  of  thoracic  diseases 
can  never  be  doubtful.  Skill  in  auscultation  requires 
application ;  and,  even  with  the  greatest,  doubt  will  fre- 
quently exist.    The  stethescope  does  not  render  the 


THE  PULSE.  t 1 

parietes  of  the  chest  transparent.  Percussion  and  aus- 
cultation merely  open  a  new  set  of  symptoms  to  our 
notice;  and,  as  diagnosis  is  certain  in  proportion  to  the 
number  and  nature  of  the  facts  on  which  it  is  founded, 
and  the  percussor  and  auscultatory  with  all  the  same 
means  of  judging  as  his  opponents,  possesses  others  in 
addition,  he  is  better  qualified  to  form  an  opinion ;  and 
though  he  may  sometimes  still  regret  his  want  of  cer- 
tainty, he  knows  that  by  shutting  his  ears,  by  levelling 
himself  with  his  opponents,  he  augments  his  uncertainty 
a  hundred  fold."  \ 

The  alleged  errors  of  those  who  practise  auscultation 
are  no  arguments  against  it.  Many  tales  of  this  de- 
scription, like  those  of  the  errors  of  Phrenologists,  have, 
when  traced  to  their  origin,  proved  inaccurate,  or  even 
altogether  destitute  of  truth;  and  eagerly  catching  at 
them  would  betray  a  mind  hoping  that  no  fresh  know- 
ledge is  to  "be  attained.  Persons  who  have  no  skill  will 
pretend  to  it,  and  the  skillful  will  sometimes  give  a 
hasty  judgment,  but  as  in  Phrenology,  nature  is  open 
to  all.  Let  every  one  examine  for  himself — examine 
carefully  and  patiently — not  anxious  to  find  it  a  decep- 
tion, but  hoping  to  find  the  promise  of  mew  information 
fulfilled. 


THE  PULSE. 

In  giving  the  number  of  pulsations,  and  the  mode 
and  manner  of  examining  the  pulse,  we  have  been  quite 
particular  in  consulting  authorities,  viewing  a  proper 
knowledge  of  this  symptom  as  the  most  essential  to  the 


72 


THE  PULSE. 


scientific  man.  After  patient  research  of  Heberden, 
Falconer,  Robinson,  Celsus,  Rush,  Tueedie,  Bell,  Stewart- 
son  and  Eherle,  it  requires  some  education  of  the  finger 
to  appreciate  with  exactness  the  several  varieties  of 
pulse,  even  those  which  are  practically  important ;  there 
are  many  varieties  mentioned  which  are  useless  and 
unnecessary.  The  pulse  varies  with  the  age  of  indivi- 
duals; at  birth  it  beats  from  130  to  140  in  a  minute; 
mean  rate  for  the  first  month  is  120;  limits  during  the 
first  year  are  106  to  120;  for  the  second  year  from  90 
to  100;  for  the  third  ^ear  from  80  to  90;  nearly  the 
same  for  the  fourth,  fifth,  and  sixth  years ;  in  the  seventh 
year  pulse  about  78  to  80 ;  from  the  twelfth  year  it  differs 
but  little  from  that  of  adult  age,  which  is  estimated  at 
from  60  to  80,  according  to  individual  constitutions,  &c. 
The  common  standard  of  frequency  may  be  placed  at 
from  70  to  75  beats  in  a  minute.  From  the  45th  to  the 
60th  year,  the  pulse  gradually  becomes  slower;  after 
this  period  it  again  rises  in  frequency.  Generally  more 
frequent  in  women  than  in  men.  Climate  influences 
pulse ;  more  frequent  in  hot  than  in  cold  countries. 

The  Time  of  Bay. — Slower  in  the  morning  than  at 
other  times;  most  frequent  soon  after  dinner;  slower 
during  sleep  than  in  the  waking  state.  Bodily  exercise 
accelerates  the  pulse;  varies  according  to  the  position 
of  the  body;  slowest  while  lying  down;  slower  when 
sitting  than  standing.  MentSl  excitement  influences 
•  the  pulse;  joy  and  anger  render  it  fuller  and  more  fre- 
quent; grief,  sorrow  and  fear  depress  it. 

Mode  of  Examining  the  Pulse. — Not  to  be  examined 
immediately  on  entering  the  patient's  room;  the  exami- 
nation to  be  repeated  at  short  intervals;  should  be  felt 
on  both  wrists,  the  arm  having  its  muscles  relaxed  by 


THE  PULSE. 


73 


proper  positions;  two  or  three  fingers  to  be  applied  to 
the  artery ;  thirty  or  forty  pulsations  are  to  be  felt  at 
each  examination;  examined  in  different  positions  of 
the  body ;  talking,  whilst  examining  the  pulse,  should 
be  forbidden. 

Pathological  Condition  of  the  Pulse. — Considered'  in 
relation, 

1.  To  the  force  of  the  pulsations. 

2.  To  the  rythm  or  mode  of  the  pulsations. 

The  most  prominent  and  useful  pathological  states  of 
the  pulse,  consist  in  frequency,'  quickness,  strength,  ful- 
ness, hardness,  and  irregularity. 

A  frequent  Pulse  is  one  in  which  the  pulsations  suc- 
ceed each  other  with  preternatural  rapidity;  a  pulse 
beating  more  than  160  in  a  minute  is  scarcely  to  be 
counted;  great  frequency  of  pulse  always  connected 
with  great  prostration  of  the  vital  energies;  frequency, 
with  fullness  and  strength  of  pulse,  more  dangerous  than 
the  same  degree  of  frequency,  with  softness  and  mode- 
rate fullness.  When  it  rises  above  120  in  inflammatory 
fevers,  much  danger  is  to  be  apprehended. 

Slow  Pulse. — Occurs  from  cerebral  compression,  in- 
ternal venous  congestions,  and  impairment  of  the  vital 
energies,  as  in  apoplexy,  congestive  fevers,  and  malignant 
fevers. 

Quickness  of  Pulse. — Often  confounded,  improperly, 
with  frequency.  Quickness  refers  to  the  suddenness 
with  which  each  individual  pulsation  is  made ;  frequen- 
cy has  reference  to  the  number  of  pulsations  in  a  given 
time.  Quickness,  however,  is  generally  attended  by 
frequency. 

Strong  Pulse  is  one  which  gives  the  sensation  of  pre- 
ternatural resistance  to  the  finger  during  the  diastole ; 


74 


THE  PULSE. 


(the  contraction  of  the  heart,)  not  to  be  confounded  with 
a  hard  pulse.  It  is  hard  when  the  artery  is  felt  firm 
under  the  finger  like  a  tense  cord,  both  in  its  systole  and 
diastole^-sometimes  called  corded.  Strength  and  great 
frequency  are  never  united,  a  strong  pulse  seldom  ex- 
ceeding 115  beats  in  a  minute.  A  strong  pulse  indicates 
energy  of  the  vital  powers,  and  is  therefore  favorable. 

A  feeble  Pulse,  the  reverse  of  a  strong  pulse.  It  is 
feeble  when  the  artery  produces  a  weak  impulse  against 
the  finger  during  its  diastole.  Feebleness  and  softness 
of  pulse  not  synonymous ;  the  artery  may  resist  pressure 
and  yet  pulsate  very  feebly.  The  pulse  is  soft  when 
the  artery  appears  to  be  filled,  and  yet  offers  no  resist- 
ance, vanishing  by  slight  pressure. 

A  very  soft  Pulse,  seldom  attended  with  great  fre- 
quency, or  with  irregularity ;  occurring  in  the  advanced 
stages  of  fevers,  favorable ;  when  joined  with  great  diffi- 
culty of  respiration  and  suffused  countenance,  in  pneu- 
monic inflammation,  indicative  of  much  danger. 

Full  Pulse,  never  very  frequent;  sometimes  much 
slower  than  natural. 

Small  Pulse,  the  diameter  of  the  artery  is  smaller 
than  natural ;  in  inflammation  seated  above  the  dia- 
phragm the  pulse  is  generally  full ;  when  seated  below 
it,  it  is  small. 

Depressed  Pulse  small  and  apparently  feeble,  and 
occasionally  quick ;  does  not  depend  on  actual  debility 
or  exhaustion,  but  on  internal  venous  congestion.  Cold 
bath  will  raise  this  pulse ;  distinguished  from  a  small 
and  weak  pulse,  by  attending  to  the  prevailing  diathesis, 
by  using  the  cold  bath  and  watching  its  effects,  and  by 
observing  the  period  of  the  disease  in  which  it  occurs ; 
if  it  is  small  and  obscure  in  the  beginning  of  acute  dis- 
eases, we  may  presume  it  is  depressed. 


THE  PULSE. 


75 


Intermittent  Pulse,  when  not  attended  by  other 
alarming  symptoms,  not  in  general  a  dangerous  sign ; 
pulse  sometimes  habitually  intermits ;  it  is  said  to  be  of 
dyspeptic  origin.  Occurs  frequently  in  old  age,  and 
then  probably  depends  commonly  on  some  affection  of 
the  heart.  Occurs  also  in  affections  of  the  brain ;  a  very 
unfavorable  sign  in  the  advanced  stage  of  fevers,  with 
great  prostration ;  is  said  frequently  to  precede  a  critical 
diarrhoea. 

Unequal  Pulse,  synonymous  with  irregular  pulse ; 
characterized  by  a  constant  variation  of  the  pulsations 
in  frequency,  quickness,  size,  hardness,  &c. ;  more  dan- 
gerous than  intermittent  pulse.  Dicrotus  pulse,  twice 
beating. 

Undulating  Pulse ;  a  wave-like  rising  and  falling  of 
the  pulse ;  generally  large,  soft  and  feeble ;  when  very 
small  it  is  termed  creeping ;  highly  dangerous. 

A  morbidly  natural  Pulse  occurs  in  malignant  fevers ; 
exceedingly  unfavorable ;  can  only  be  distinguished  from 
a  healthy  pulse  by  the  concomitant  symptoms. 

Shattered  Pulse  feels  like  a  shattered  quill  under  the 
finger.    Occurs  in  opium  eaters. 

Obstructed  Pidse  ;  artery  remains  equally  full  during 
its  diastole  and  systole. 

Compound  Pulses  ;  the  principle  are  the  synocha,  syno- 
clius,  synoclmla,  typhoid  and  typhus. 

1.  Synocha,  hard,  full,  frequent  and  strong;  indicates 
high  inflammatory  excitement. 

2.  Synochus,  full,  round,  active,  but  not  hard;  occurs 
in  the  hot  stage  of  intermittents,  in  remittents. 

3.  Synoclmla,  quick,  tense,  small,  hard,  vibrating ; 
occurs  in  sub-acute  rheumatism,  inflammation  of  the 
intestines,  peritoneum,  &c.    It  is  the  hectic  pulse. 


76 


OF  FEVERS  IN  GENERAL. 


4.  Typhoid,  quick,  small,  slightly  tense,  not  hard,  and 
somewhat  frequent ;  in  the  advanced  .stages  of  bilious 
fevers — the  result  of  irritation  in  an  exhausted  state  of 
the  system. 

5.  Typhus,  small,  very  frequent,  somewhat  quick; 
occurs  in  the  advanced  stages  of  jail,  hospital,  and  other 
varieties  of  typhoid  fevers. 


OF  FEVERS  IN  GENERAL. 

Idiopathic. — We  mean  by  this  term  a  disease  which 
does  not  depend  on  any  other,  and  in  which  respect  it 
is  opposed  to  a  systematic  disease  which  is  dependant 
on  another. 

Symptomatic. — Dependant  on ;  local  irritation,  partial 
or  general;  inflammation,  "which  we  generally  find 
seated  in  the  mucous  tissues,  frequently  in  the  serous." 

Proximate  cause. — Some  contend  that  the  cause  is 
located  in  "  the  capillary  system  of  blood  vessels,  and 
that  the  morbid  actions  of  the  heart  and  arteries  are 
mere  sympathetic  phenomena,  dependant  on  a  primary 
local  irritation  of  a  part  or  the  whole  of  the  sanguiferous 
capillary  system ;"  and  this  is  from  no  mean  authority. 
Kespecting  the  proximate  cause,  I  might  say,  and  with 
truth,  there  have  been  an  hundred  hypothesis.  Some 
contend,  and  assert  it  as  a  fact,  that  the  disease  is  all  in 
the  solids ;  others  assume  as  a  fact,  that  the  disease  is 
confined  exclusively  to  the  fluids.  Now,  we  contend, 
that  all  changes  which  take  place  in  the  fluids  are  most 
probably  owing  to  the  solids  in  the  first  instance.  A 
morbid  cause  makes  an  unnatural  impression  upon  the 


OF  FEVERS  IN  GENERAL. 


77 


general  system  as  a  living  body ;  it  impresses  the  solids, 
and  by  the  action  of  the  solids  the  fluids  are  secreted  in 
a  vicious  manner  and  of  an  unwholesome  quality.  There 
are  various  other  reasonings  that  we  could  cite,  but  as 
our  object  is  to  give  a  brief  outline  of  fevers,  their  causes, 
&c.  in  general,  we  refer  readers  to  works  that  have 
entered  largely  upon  this  portion  of  our  subject,  and  I 
can  only  assure  you,  in  your  perusals  you  will  find  many 
assumptions.  <£  Anything  may  be  said  in  physic,  but 
anything  may  not  be  right." 

Remote  causes  of  Fever, — Are  divided  into  predis- 
posing and  exciting.  There  exists  no  essential  difference 
between  the  predisposing  and  exciting  cause.  Every 
predisposing  cause  may  become  an  exciting  cause  by 
continued  or  intense  action.     So  says  Bell,  Eberle, 
Stewartson  and  Cook.    We  believe  that  most  of  the 
remote  causes  of  fever  do  not  produce  epidemic  disease ; 
the  predisposing  causes  are :   an  anxiety  of  the  mind, 
grief,  an  over-exertion  of  the  mental  faculties,  extraordi- 
nary muscular  exertion,  excess  of  venery,  and  all  cir- 
cumstances of  a  debilitating  character.  Predisposing 
causes  soon  become  an  exciting  cause,  when  pushed  too 
far ;  such  as  an  excess  in  venery,  &c.    One  cause,  most 
certainly,  of  continued  fever,  is  an  exposure  to  cold, 
more  especially  when  the  body  is  over-heated.  Cold 
again,  will  sometimes,  it  is  said,  produce  epidemic  dis- 
eases, but  rarely,  except  in  conjunction  with  the  cause 
of  autumnal  fever.    However,  it  is  but  too  true,  that 
from  Sept.  '46  to  April  of  '47,  cold  was  the  cause  of  an 
epidemic  in  the  county  of  Grimes  and  adjacent  country. 
I  style  it  an  epidemic  because  it  was  almost  universal, 
pneumonia,  (vulgarly  termed  winter  fever.)    Famine  is 
capable  of  producing  epidemic  disease,  and  epidemics 


78 


OF  FEVERS  IN  GENERAL. 


are  annual  in  many  parts  of  the  world.  It  is  in  the 
summer  or  hot  months,  almost  universally,  that  epide- 
mic diseases  prevail. 

Predi&positwn. — General  debility  but  seldom,  most 
commonly  confining  itself  to  some  local  organ.  In 
drawing  our  deductions  from  our  past  reading,  to  arrive 
at  conclusions  for  the  predisposing  causes  of  ague,  the 
first  that  presents  itself  for  consideration  is  bad  health. 
A  distinguished  author  says,  "if  a  person  be  out  of 
health  in  any  respect,  he  is  more  likely  to  be  the  cause 
of  ague."    Our  own  impression  is,  whether  in  health  or 
out  of  health,  that  in  this  climate  the  general  system, 
from  the  effects  of  heat,  is  so  much  relaxed,  that  the 
least  change  of  weather  predisposes  us  to  ague.    And  it 
is  under  this  head  that,  with  feelings  .  of  some  reluc- 
tance, I  feel  it  to  be  an  imperative  duty  to  state,  that 
in  this  climate  our  systems  require  a  stimulant;  I  am 
well  aware  of  the  general  hypothesis,  and  concede  that 
associations  for  temperance  are  well  calculated  to  do 
good,  but  nevertheless,  to  carry  it  to  the  extent  of  con- 
fining entirely  to  cold  water,  I  am  well  convinced 
would,  in  many  instances  produce  disease.    I  am  well 
aware  in  assuming  this  position  that  there  are  persons 
belonging  to  Temperance  Societies,  whose  anathemas  I 
will  receive,  but  an  author  should  have  but  one  guide, 
to  write  conscientiously  his  views,  and  to  state  them 
boldly;  and  arriving  at  my  conclusions  from  some  of 
the  most  distinguished  authors  of  the  present  day,  and 
accompanied  with  my  own  experience,  I  assert,  that  in 
this  climate  to  keep  up  the  general  vigor  of  the  body,  it  is 
necessary  to  drink  in  moderation  small  portions  of  wine. 
I  think  good  claret  the  most  preferable.    In  support  of 
this  position  I  refer  you  to  Gregory's  "  Conspectus  Medi- 


OF  FEVERS  IN  GENERAL. 


79 


cinae  TJieoreticae"  wherein  lie  asserts  when  a  student  at 
Leyden  there  were  twenty-four  students,  who  always 
dined  together,  and  were  very  much  in  each  others  so- 
ciety ;  twenty-three  of  them  conceived  it  to  be  necessary 
to  avoid  the  ague  to  keep  up  a  slight  excitement ;  there 
was  one  whose  opinions  were  the  reverse,  and  confined 
himself  to  cold  water;  the  twenty-three  escaped,  but 
the  water  drinker  caught  an  intense  ague.  This  cer- 
tainly exemplifies  the  necessity  of  keeping  up  the  vigor 
of  the  body,  and  strength  of  mind  to  resist  disease. 
The  French  authors  assure  us,  (and  for  their  authority 
the  world  can  produce  no  better,)  that  it  is  indispensa- 
ble in  the  marshy  parts  of  France,  to  drink  wine  in 
moderation  to  resist  the  ague.  Dr.  Elliotson  asserts  that 
Sir  John  Pringle  mentions  that  wine  in  moderation, 
and  a  full  diet,  are  the  best  safeguards  against  it.  In 
Gregory's  Study  of  Medicine  you  find  the  same  opinion. 
Dr.  Stewartson  asserts  that  the  Dutch  are  in  the  habit 
of  exciting  themselves  by  taking  spirits  before  they  go 
out  in  the  morning,  and  their  physicians  contend  that 
it  is  highly  necessary,  exposed  as  they  are  to  the  exha- 
lations of  an  impure  atmosphere.  I  am  aware  that 
these  opinions  are  counter  to  those  entertained  by  many, 
and  more  especially  to  some  benevolent  societies,  insti- 
tuted for  the  suppression'of  drinking  intoxicating  liquors; 
but  the  major  part,  or  at  least  the  intelligent  of  those 
societies,  will  discover  that  my  opinions  approach  near 
to  theirs,  and  if  used  in  the  manner  proposed,  that  no 
harm  would  result  therefrom. 

The  origin  of  all  possible  cause  of  Fever,  says 
Chisholm  and  Eberle,  is  quadruple.  1st.  "  Retained 
recrementitious  materials,  in  consequence  of  the  acci- 
dental torpor  of  one  or  more  of  the  emunctories. 


80 


OF  FEVERS  IN  GENERAL. 


2d.  Substances  generated  in  the  system,  independent 
of  organic  actions,  worms,  &c. 

3d.  Materials  generated  out  of  the  body — miasmata, 
heat,  cold,  &c. 

4th.  Substances  generated  by  diseased  organic  ac- 
tion s — cont  agious  " 

To  the  most  of  these  propositions  we  cordially  agree ; 
but  with  due  deference  to  the  authority  from  whence 
they  spring,  we  beg  leave  not  to  attach  so  much  impor- 
tance to  miasmata,  as  is  generally  conceded  by  the  author 
and  the  most  of  Southern  physicians.  We  will  notice 
our  objections  under  the  head  of  the  cause  of  fever. 

The  causes  of  Fever  are  divided  into  three  classes: 

1.  The  atmosphere,  its  sensible  properties — heat,  cold, 
moisture,  electricity. 

2.  Contagious — the  result  of  organic  action. 

3.  Miasmata — the  result  of  physical  changes. 
Heat — Specific  temperature  of  the  human  body,  98°. 

Heat  alone,  however,  in  its  usual  degree  in  the  warmest 
climates,  is  not  sufficient,  most  certainly,  to  produce 
epidemics;  in  temperate  climates  the  hot  months  are 
the  time  of  sickness ;  moisture  is  also  necessary.  It  has 
been  contended  that  moisture  is  not  essential  for  mias- 
mata; but  in  my  humble  opinion  it  cannot  be  sustained. 
The  hot  climates  within  the  tropics,  which  are  almost 
universally  healthy  during  the  warm  and  dry  season, 
soon  become  sickly  after  the  rain  commences,  and  con- 
tinues so  throughout  the  whole  season.  Drs.  Cook  and 
Ferguson  assert  the  rainy  and  sickly  season  are  syno- 
nymous terms.  Heat,  no  doubt,  increases  the  secretion 
of  bile. 

Cold  causes  a  contraction  or  shrinking  of  the  body, 
produces  irresistible  disposition  to  sleep,  and  when  ap- 


OF  FEVERS  IX  GENERAL. 


81 


plied  suddenly  excites  the  nervous  system;  its  alterna- 
tions with  heat  is  a  fertile  source  of  disease,  generally 
resulting  in  affections  of  the  chest,  pneumonia,  colds,  or 
rheumatism.  "  Cold  water  externally  applied,  or  taken 
into  the  stomach  when  the  body  is  heated,  and  in  a  free 
state  of  perspiration,  often  proves  suddenly  fatal." 

Miasmata  are  seldom  generated  at  a  temperature  be- 
low 80°;  their  precise  nature  unknown;  there  is  reason 
to  believe  that  they  consist  of  particles  of  putrid  veget- 
ables and  animal  matter,  dissolved  in  aqueous  vapor. 
Periodical  fevers  are  met  with  in  mountainous  districts 
in  the  interior  of  some  of  the  islands,  at  an  elevation  of 
six  hundred  feet,  and  amongst  a  series  of  mountainous 
ridges  not  exposed  to  currents  of  exhalations  from 
swampy  and  low  grounds.  We  therefore  conclude  that 
heat  and  moisture  are  not  sufficient  to  produce  epidemic 
disease.  Something  more  is  necessary,  and  may  be  dis- 
covered by  attention  to  the  situation  and  circumstances 
of  the  places  most  liable  to  these  diseases. 

Contagion. — By  " contagion  is  generally  meant,  I  be- 
lieve, either  a  peculiar  matter  generated  in,  or  a  de- 
praved secretion  of  a  living  system  under  disease; 
capable  of  producing  the  same  disease  in  others,  when 
there  is  no  indisposition  to  it;  and  more  especially  if 
there  be  a  predisposition."  The  diseases  produced  by 
this  class  of  causes  preserve  a  determined  or  specific 
character;  you  may  divide  into  chronic  and  acute;  the 
latter  seldom  affect  more  than  once,  the  former  may 
affect  repeatedly.  "  Typhus  fever,  under  certain  cir- 
cumstances, contagious;  appears  to  be  propagated  by 
effluvia  only."  Contagion  is  rendered  more  or  less 
harmless  by  free  ventilation ;  it  will  attach  itself  to  va- 
rious substances ;  those  most  apt  to  receive  it  and  retain 
6 


82 


INTERMITTENT '  FEVER. 


it  are  wool,  cotton,  chairs  stuffed  with  hair,  cotton 
cloths,  &c.  The  best  disinfecting  means  are  cleanli- 
ness, free  ventilation,  muriatic  vapors,  lime,  fumes  of 
sulphur,  and  heat. 


PARTICULAR  FEVERS, 

INTERMITTENT  FEVER. 

At  the  present  time,  especially  in  this  country,  it 
would  be  superfluous  to  enter,  at  any  considerable 
length,  into  the  details  of  the  treatment  appropriate  to 
the  simple  intermittent  form  of  periodical  fever.  The 
management  of  this  character  of  fever  has,  to  a  great 
extent,  been  taken  out  of  the  hands  of  the  profession 
by  the  patients  themselves,  or  their  friends;  but  more 
frequently  by  an  over-weening  confidence  in  some  pa- 
tent nostrum  for  their  cure.  I  have  in  this  climate  seen 
sad  results  in  mal-practice  for  this  form  of  fever,  and  it 
has  been  a  matter  too  much  overlooked  by  the  profes- 
sion; the  public  generally  resort  to  these  patent  nos- 
trums, all  of  which  contain  an  anti-periodic  property — 
either  quinia  or  arsenic — and  the  result  generally  is, 
that  the  system  not  being  prepared  for  their  action,  harm 
generally  is  the  result;  a  train  of  diseases  follow — 
dropsy,  &c. 

Pyrexia. — By  this  we  mean  the  absence  of  fever 
during  the  firsthand  second  reaction.  In  inflammation 
there  are  only  two  stages  well  developed,  which  are 
cold  and  heat;  but  in  fever,  especially  intermittent,  we 
have  three,  a  cold,  a  hot,  and  a  sweating  stage ;  these 


INTERMITTENT  FEYER. 


83 


are  always  well  developed;  the  first  symptom  which 
presents  itself  in  this  disease  is  the  cold  stage. 

Cold  Stage. — The  patient  has  indescribable  sensations 
of  feeling,  a  great  desire  to  yawn  and  stretch,  and  a 
chilly  sensation  along  his  spine ;  he  soon  begins  to  trem- 
ble slightly,  and  in  a  few  minutes  complains  of  being 
very  cold,  and  in  many  instances  his  jaws  chatter,  the 
skin  becomes  very  rough,  and  the  urine  which  he  makes 
at  the  time  is  very  pale,  and  in  small  quantities ;  the 
pulse  is  weak,  and  generally  very  slow;  sometimes 
nausea  and  vomiting;  finger  nails  become  blue.  The 
relation  between  the  violence  and  duration  of  the  stage 
is  direct;  the  former  being  violent  and  short,  the  re- 
action will  be  apt  to  be  vigorous;  weak  and  lengthy 
chills  usually  followed  by  feeble  reaction.  A  chill  oc- 
curring in  the  advanced  period  of  a  remittent,  indicates 
that  it  is  about  altering  its  type  or  form. 

Hot  Stage. — In  the  cold  stage  the  blood  recedes  from 
the  surface,  and  accumulates  in  the  large  vessels;  it 
here  regains  its  warmth,  and  the  pulse  soon  becomes 
very  full  and  rapid,  and  creates  such  an  excitement  as 
to  produce  pain  and  throbbing  in  the  head,  the  eyes 
become  prominent,  a  dry  skin,  urine  small,  and  high 
colored. 

Siveating  Stage.— After  the  hot  stage  the  skin  becomes 
soft,  perspiration  is  profuse  and  general,  urine  copious, 
and  a  cessation  of  pains  in  the  head,  loins,  &c. 

Incidental  Symptoms. — We  have,  occasionally,  these 
symptoms,  such  as  fainting,  delirium,  and  at  times,  the 
appearance  of  petecchice  on  the  surface ;  by  this  term  we 
mean  red  or  purple  spots.  Pringle  mentions,  as  the 
character  of  an  epidemic  which  he  saw  prevail,  violent 
delirium  with  a  clinching  of  the  hands,  &c. 


84 


INTERMITTENT  FEVER. 


Periodical  Recurrence. — These  stages  frequently  all 
take  place  in  twenty-four  hours,  but  they  are  various  in 
regard  to  duration ;  beyond  two  days  the  intermission  is 
rarely  regular  in  this  climate,  If  the  attack  returns 
every  day  the  fever  is  called  "  quotidian."  If  there  be 
an  intermission  of  a  whole  day,  in  medicine  we  mean 
twenty-four  hours,  it  is  called  "  tertian."  If  the  inter- 
mission extend  two  days,  it  is  then  called  "  quartan ;" 
this  will  bring  the  attack  eveiy  third  day.  We  seldom 
have  intermission  in  this  country  longer,  but  cases  are 
reported  where  the  paroxysm  has  been  known  to  return 
every  sixth  or  seventh  day. 

The  body  sometimes  only  parti  ally  affected. — Cases  are 
reported  where  the  paroxysm  only  affected  one  half  of 
the  body.  Abercrombie  cites  a  case  of  a  friend,  who 
only  perspired  in  violent  exercise  in  a  vertical  half  of 
the  body.  I  have  a  friend  of  this  description,  Mr. 
Harper,  who  was  clerk  of  the  Probate  Court  of  Grimes 
County.    I  never  considered  him  a  healthy  man. 

It  affects  any  period  of  life. — Ague  affects  all  ages,  from 
childhood  to  old  age.  I  have  had  under  my  care  seven 
German  patients  over  the  age  of  forty-five,  and  in  every 
instance,  upon  the  cessation  of  the  paroxysms,  anasarese 
made  its  appearance ;  by  this  term  we  mean  one  of  the 
stages  of  dropsy,  which,  however,  was  easily  removed. 
Quinine  was  administered  without  any  preparatory  treatr 
ment. 

It  is  liable  to  return. — When  it  has  once  occurred,  the 
person  is  ever  afterwards  liable  to  its  return ;  cold,  wet, 
and  the  east  wind  have  a  particular  tendency  to  bring 
it  back.  I  do  not  think  it  will  recur  spontaneously,  but 
I  am  satisfied  that  cold,  wet  and  an  east  wind  will  fre- 
quently bring  it  back. 

Complications  of  Ague. — It  is  frequently  complicated 


INTERMITTENT  FEVER. 


85 


with  rheumatism.     It  will  sometimes  alternate  with 

i 

rheumatism,  sometimes  one  will  have  precedence,  then 
the  other. 

Local  InfammaMon. — Ague  is  frequently  attended  by 
inflammation,  frequently  inflammatory  affections  of  the 
chest,  but  in  this  climate  it  is  confined  in  a  large  majo- 
rity of  cases  to  the  abdominal  viscera. 

Congestion  and  Effusion. — A  very  distinguished  author, 
who  has  made  frequent  autopsical  examinations,  says, 
after  death,  during  intermittent  fever,  we  often  find  con- 
gestion  and  effusion  in  the  head,  chest  or  abdomen.  The 
mucous  surface  of  the  alimentary  canal  is  likewise  in  a 
state  of  great  congestion,  and  the  liver  contains  a  large 
quantity  of  bile.  When  this  disease  proves  fatal,  it  fre- 
quently does  so  by  great  internal  congestion ;  whence 
there  is  fullness  of  all  the  blood  vessels  of  the  head, 
chest,  stomach  and  intestines,  and  a  large  quantity  of 
bile  on  the  liver.  When  the  disease  has  continued  for 
a  considerable  time  we  have  various  organic  affections, 
such  as  dropsy  and  other  diseases  which  I  shall  men- 
tion hereafter.  But  when  a  patient  dies  in  a  paroxysm, 
or  dies  after  the  disease  has  existed  only  for  a  short 
time,  we  find  decided  marks  of  internal  congestion. 

Enlargement  of  the  Spleen. — "  The  chronic  form  of  the 
disease  is  very  frequently  attended  by  other  affections, 
and  frequently  after  ague  has  ceased  other  diseases 
make  their  appearance.  It  is  very  common,  for  example, 
when  ague  has  continued  any  time,  for  the  spleen  to 
become  enlarged.  So  common  is  this  in  some  places, 
that  the  tumor  is  called  by  persons  "  ague-cake."  The 
tumor  thus  formed  by  the  spleen,  occupies  the  left  hypo- 
chondrium,  or,  frequently,  I  may  say,  the  whole  left 
half  of  the  abdomen.  Spleens  are  reported  whose  weight 
exceeded  twelve  pounds.    Enlargements  of  the  spleen 


86 


INTERMITTENT  FEVER. 


and  liver  is  ^common,  but  particularly  of  the  former.  In 
the  case  of  spleen  the  patient  is  for  the  most  part  pale ; 
while  in  the  case  of  the  liver  he  becomes  more  or  less 
jaundiced." 

Diagnosis  and  Prognosis  have  been  given  briefly  in 
the  fore  part  of  the  work,  and  we  view  it  as  superfluous 
to  recapitulate. 

Treatment. — The  means  which  we  adopt  to  eradicate 
this  fever  we  divide  into  two — remedies  for  the  inter- 
mission, and  those  during  the  paroxysm  of  the  disease ; 
with  regard  to  the  latter  they  are  numerous,  and  pre- 
scribed to  alleviate  rather  than  to  the  cure. 

Cold  Stage. — Little  is  ever  attempted  to  be  done  at 
this  time.  Plenty  of  cover,  with  the  aid  of  warm  drinks, 
should  be  resorted  to,  but  by  no  means  should  they  be 
of  a  stimulating  character.  I  have  frequently  prescribed 
opium  in  this  stage ;  where  there  was  no  evidence  of 
congestion  upon  the  brain,  it  will  most  certainly  shorten 
it,  and  in  many  instances  alleviate  it. 

Bleeding  in  the  Cold  Stage. — This  has  been  proposed, 
and  in  favor  of  which  there  is  strong  testimony.  We 
certainly  have  more  powerful  congestion  in  this  climate 
than  they  have  in  a  more  northern  latitude,  and  it  is 
quite  common  to  have  congestion  to  such  an  extent  as 
to  prove  fatal,  if  it  were  not  speedily  relieved.  Dr. 
Mackintosh  and  others  recommend  this  practice  very 
highly ;  it  seems  rather  to  alleviate  than  to  cure.  I 
never  have  resorted  to  bleeding  in  the  cold  stage  of  in- 
termittent, from  never  having  had  a  case  that  I  thought 
required  it.  Dr.  Mackintosh  says  it  is  always  safe,  often 
shortens  and  sometimes  cures.  Dr.  Lind  says,  he  and 
two  other  friends  had  three  patients  each,  each  bled 
their  patients  and  the}'  all  lost  one.    I  have  no  doubt  it 


INTERMITTENT  FEVER. 


87 


is  a  remedy  that  might  be  resorted  to,  where  we  found 
extraordinary  symptoms  of  congestion.  Dr.  Drake  says, 
if  there  is  a  determination  to  the  brain,  you  should  use 
the  lancet,  or  where  you  have  a  muscular  agitation, 
bleeding  will  soon  re-establish  re-action.  With  due 
deference  to  this  high  authority,  we  must  dissent  from 
the  indiscriminate  use  of  the  lancet,  and  in  doing  so,  we 
will  state  briefly  our  reasons : 

1st.  We  have  been  successful  in  curing  intermittent 
without  resorting  to  the  lancet. 

2d.  In  this  climate  our  systems  are  very  much  re- 
laxed, and  re-action  is  generally  very  slow  in  its  cha- 
racter, and  the  type  of  disease  is  very  easily  changed, 
consequently,  we  contend,  to  bleed  in  the  cold  stage  of 
intermittent  fever  would  be  running  considerable  risk, 
and  in  case  reliction  did  not  take  place,  it  would  be  the 
means  of  changing  a  common  intermittent  into  that  of 
congestive  fever.  We  would  not  be  understood  to  say 
that  we  would  never  use  the  lancet,  but  we  are  of 
opinion  we  would  not  unless  our  patient  was  robust  and 
plethoric.  As  a  general  rule  it  is  inadmissible,  and 
therefore  requires  a  sound  judgment  when  you  resort  to 
the  lancet.  I  have  no  prejudice  against  the  lancet,  but 
would  be  understood  to  say  that  I  have  never  seen  a 
case  of  fever  wherein  I  deemed  it  necessary.  Use  it 
seldom,  if  ever. 

Hot  Stage. — When  this  stage  comes  on  we  frequently 
give  small  portions  of  cream  of  tartar,  but  a  treatment 
that  I  adopt  in  a  very  large  majority  of  cases  is,  to  give 
about  ten  grains  of  Dover's  powders,  to  be  followed  with 
warm  sage  tea,  or  an  infusion  of  wild  horehound,  to  bring 
on  the  sweating  stage  as  soon  as  possible ;  if  this  does 
not  produce  the  desired  effect  I  repeat  the  dose  every 


88 


INTERMITTENT  FEVER. 


half  hour  until  there  is  a  free  determination  to  the  sur- 
face.   I  have  used  opium  in  both  stages  to  advantage. 

Sweating  Stage. — When  this  period  arrives  the  pa- 
roxysm is  nearly  at  an  end.  We  now  continue  slightly 
warm  diluents ;  we  do  not  suffer  the  cold  air  to  blow  on 
him.  If  the  patient  be  very  weak  we  can  give  him  weak 
stimulants,  at  the  same  time  taking  care  to  observe  that 
no  local  congestion  or  inflammation  be  present. 

Dmrmg  the  Intermission. — All  the  principal  remedies 
should  be  employed  during  the  intermission.  The  two 
chief  remedies  in  the  cure  of  this  disease  is  quinine  and 
arsenica ;  quinine  is  best  given  in  a  fluid  state,  and  there 
should  be  a  slight  addition  of  sulphuric  acid,  by  means 
of  which  a  super-sulphate  is  made.  No  general  rule 
can  be  laid  down  respecting  the  quantity  required,  but 
our  usual  mode,  when  given  to  arrest  the  paroxysm,  is 
to  give  five  grains  quinine  and  one  grain  piperine  every 
four  hours.  We  give  our  general  treatment  in  the  report 
of  two  cases,  also  our  recipe  for  making  Massie's  Tonic 
Pill,  which  in  our  hands  seldom  fail  in  producing  a  speedy 
return  to  health. 

Mr.  B.  had  quotidian  fever  four  weeks ;  he  was  con- 
stipated, with  dull  percussion  over  the  liver.  Five  grains 
of  blue  mass  was  ordered ;  in  a  few  hours  afterwards 

Nitrate  of  potash   -       -       10  grs. 

Quinine        -  5  " 

were  ordered  every  three  hours  during  the  intermission. 
He  had  a  second  paroxysm,  and  I  ordered  bark  in  sub- 
stance, to  produce  a  healthy  tone, 

Barks  5ss.  which  is  30  grs. 

Cream  tartar     5s$.       "  " 
every  four   hours.     Patient  recovered   without  any 
further  assistance. 


INTERMITTENT  FEVER. 


89 


Mr.  G.,  24  years  of  age^  quotidian  fever  five  weeks, 
with  quite  an  enlarged  spleen ;  he  was  cupped  over  the 
spleen,  and  the  following  prescription  ordered : 
1^.    Quinine,  3  grs. 

Podophylline,  (mandrake,)  1  gr. 
Ipecacuanha,  1  gr. 

This  was  given  every  four  hours  during  the  intermis- 
sion; he  had  a  second  and  third  paroxysm,  and  became 
constipated ;  senna  tea  was  administered  to  keep  open  his 
bowels,  and  the  following  prescription  was  ordered  every 
four  hours,  which  arrested  the  paroxysms : 
Quinine,  6  grs. 

Camphor,  3  grs. 

Piperine,  1  gr. 

Arsenic,  as  I  before  observed,  is  valuable  in  this  fever; 
it  is  best  adapted  to  cases  attended  with  rather  a  full 
and  robust  habit ;  a  moderately  full,  but  soft  and  regular 
pulse,  and  unaccompanied  by  local  congestions.  In 
debilitated  or  scorbutic  habits,  (by  this  term  we  mean, 
in  the  abstract,  the  scurvy,)  often  injurious;  improper 
also  in  persons  who  have  any  affections  of  the  breast. 
Should  be  given  in  as  large  doses  as  the  stomach  will 
bear;  apt  to  produce  dropsical  swellings.  From  ten  to 
fifteen  drops  of  Fowler's  solution,  with  the  same  amount 
of  laudanum,  every  four  hours. 

Sulphate  of  Zinc  is  a  good  article  in  the  treatment  of 
this  disease;  in  combination  with  capsicum,  (cayenne 
pepper,)  I  have  found  it  quite  as  efficient  as  quinine.  I 
give  it  according  to  the  following  recipe : 
I^.    Sulph.  Zinc,        x  grs. 

Pulv.  Capsicum,  3ii.  (40  grs.  cayenne  pepper.) 
Syrup  of  ginger  sufficient  to  make  it  into  pills,  which 
I  divide  into  thirty  pills,  and  give  one  every  two  hours. 


90 


INTERMITTENT  FEVER. 


Massies  Tonic  Pill, 
fy.    Quinine,  oi.       CO  grs. 

Piperine,  5ss.      30  " 

Podophylline  (mandrake),  x  grs. 
Rhubarb,  9n.     40  " 

Capsicum,  20  " 

Oil  of  black  pepper       40  gtts.    40  drops. 
Oil  of  anise,  8    "       8  " 

Pulverize  this  well,  and  divide  into  5  gr.  pills.  My 
usual  mode  of  administering  is  to  commence  about  six 
hours  before  the  paroxysm  begins,  and  give  one  every 
hour. 

I  have  frequently  used  the  following  compound,  and 
with  the  happiest  results;  whether  it  has  ever  before 
been  introduced  to  the  profession  I  know  not,  but  from 
my  own  experience  I  can  recommend  it  as  a  valuable 
remedy.  Its  action  upon  the  spleen  is  equally  effica- 
cious as  quinine,  and  without  doubt  the  most  valuable 
succedaneum  to  quinine  which  has  yet  been  discovered. 
The  article  is  gentianine,  given  from  15  to  30  grain 
doses  twice  a  day. 

In  regard  to  quinine,  frequent  objections  are  raised  on 
account  of  its  extreme  bitter  taste.  We  have  tried 
Bouchardot's  method,  and  think  well  of  it;  he  substi- 
tutes tartaric  acid  in  lieu  of  sulphuric  acid;  it  hastens 
the  solution.  M.  Casorati  has  found  that  one  grain  of 
the  tartaric  acid  is  sufficient  to  saturate  three  of  disul- 
phate  of  quinine,  and  it  is  not  at  all  unpleasant  to  the 
taste. 

Prevention  of  Ague,  says  Dr.  Elliotson,  is  to  prevent 
all  accumulation  of  dead  vegetable  substance,  in  order 
to  prevent  as  much  as  possible  exhalations  from  putri- 
fied  vegetable  matter.    When  land  cannot  be  drained, 


INTERMITTENT  FEVER. 


91 


occasional  inundations  may  be  necessary,  in  order  to 
throw  more  water  on  it  than  is  compatible  with  veget- 
able decomposition.  AVith  regard  to  individuals  who 
must  be  exposed  to  ague,  the  best  mode  of  preventing 
it  is  to  live  as  well  as  possible,  to  have  good  food,  a  cer- 
tain portion  of  tcine  or  beer,  and  never  to  expose  them- 
selves to  malaria  with  empty  stomachs.  Smoking  is  an 
excellent  preventive  in  damp  places. 

You  will  frequently  find  persons  who  have  had  chills 
and  fever  for  a  great  while ;  these  cases  are  almost  uni- 
versally attended  with  what  is  termed  "  ague  cake,"  an 
enlargement,  and  sometimes  an  indurated  spleen,  to  re- 
move which  I  cup  freely  over  it,  scarifying  every  por- 
tion of  the  surface  over  the  enlargement,  and  then  rub 
over  the  scarified  surface  the  following  ointment.  I 
prefer,  however,  warming  the  ointment,  spreading  it 
on  leather  or  cloth,  and  keeping  it  constantly  applied. 
'  The  ointment  consists  of  the  following : 

II.    Hydriod.  potassa,  &iu. 
Simple  unguent,  Si. 
Mix  intimately,  warm  and  spread  as  directed. 

At  the  same  time  either  of  the  following  remedies 
should  be  taken. 

R.    Hydriod.  potassa,  9ii. 
Iodine,  3i. 
Aqua  distill,  (distilled  water),  Si- 
Mix  intimately,  and  give  20  drops  three  times  a  day; 
you  can  increase  the  dose  one  drop  a  day  in  chronic 
cases. 

Twining's  Recipe,  I  sometimes  use  in  lieu  of  this ;  it 
is  the  following: 


92 


INTERMITTENT  FEVER. 


fy.    Pulv.  Jalap. 

 Rhubarb. 

 Columbse. 

 Z  i  u  zi  beris — Ginger. 

 Potassa  supertartratis  aa  5i — Cream  of  tartar. 

Ferri  sulphatis  9ss. — Green  vitriol. 
Tinct.  sennae,  3iv.  » 
Aquae  menthae  sativae,  Sx. — Misce. 
The  dose  is  an  ounce  and  a  half  for  an  adult  at  6 
A.  M.,  and  repeated  at  11  A.  M.,  daily. 

For  children  the  dose  should  be  so  regulated  as  to 
produce  two  or  three  stools  daily,  not  more.  Its  action 
is  that  of  purgative,  tonic,  and  diuretic.  Where  your 
patient  is  very  costive,  I  have  frequently  added  pulv. 
scammony  comp.  9ii  to  the  mixture;  and  on  the  other 
hand,  where  they  are  easily  purged,  we  substitute  com- 
pound  tincture  of  cardamon  for  the  tincture  of  senna; 
and  if  there  be  any  disposition  to  paroxsyms  of  inter- 
mittent fever,  I  add  to  the  mixture  from  a  scruple  to  a 
drachm  of  quinine.  I  continue  this  for  ten  days,  then 
alternate  with  small  doses  of  podophyllin,  and  tinct. 
ferri.  muriat,  (which  is  muriatic  tinct.  iron,)  20  drops 
in  a  wine  glass  full  of  water,  with  3i  of  tinct.  of  gen- 
tian comp.  at  7,  and  repeated  at  11  A.  M.  These  should 
be  used  for  about  five  days,  when  you  should  return  to 
the  spleen  mixture  if  the  case  is  not  relieved. 

The  following  remedy  has  some  celebrity  in  affections 
of  the  spleen. 

3^.    Pulv.  Cinchona,  Si — Peruvian  bark. 
Cream  tartar,  gi. 
Nit.  potash,       5ii. — Nitre. 
Mix  and  triturate  intimately  together,  and  then  take 
a  tea-spoonful  before  each  meal. 


INTERMITTENT  FEVER. 


93 


You  will  frequently  find  in  this  climate  cases  where 
different  treatment  will  have  to  be  observed,  both  in 
enlarged  spleen  and  intermittent  fever;  they  are,  how- 
ever, rare  occurrences.  In  the  latter  we  have  used  the 
following  recipes  with  success. 

It.    Sulphatis  Quiniae,  gr.  xx. 

Acidi  Sulphurici,  gtts.  hi,  (drops.) 
Syrup  ginger  or  lemon,  5ii. 

Mix  well,  and  give  large  tea-spoonful  every  hour. 
We  sometimes  substitute  for  the  ginger  or  lemon,  loaf 
sugar  oh  and  cinnamon  water  giiss,  and  use  it  in  same 
doses. 

You  sometimes  find  cases  in  which  quinine  seems  to 
exert  no  influence;  in  such  cases  try  the  gentianine,  as 
has  been  before  suggested.    We  have  frequently  used 
the  following  in  such  cases  with  the  happiest  results : 
1^.    Ferrocyanitis  Quinise  gr.  viii. 
Alcohol,  oi- 
Solve  and  add, 

Aqua  Camphors,  5vi. 

Mix,  and  give  from  a  half  to  a  tea-spoonful  every  hour. 
The  arsenical  preparation  used  by  Graves,  and  which 
was  suggested  by  my  friend  Dr.  L.  A.  By  an,  of  Browns- 
ville to  me,  he  assured  me  he  has  used  it  in  these  par- 
ticular character  of  cases  with  marked  success;  he  is 
a  gentleman  in  whom  I  have  every  confidence,  and  my 
own  experience  so  far  confirms  his  statement  fully.  The 
preparation,  as  used  by  him,  is  as  follows : 

I^.    Liquorice  arsenicalis,  viii.  gtts.  (drops.) 

Water,  gi. 

Tinct.  Opii,  xv  gtts.  (drops.) 

Spirits  Lavend.  comp.  5ss. 


94 


INTERMITTENT  FEVER. 


To  be  taken  at  a  dose.  It  does  not  irritate  the  stomach 
like  the  simple  arsenic  solution. 

The  following  remedies,  although  one  of  which  is  ex- 
tremely simple,  you  will  find  valuable  under  many  cir- 
cumstances ;  the  first  is  a  good  remedy  when  there  is  a 
disposition  to  vomiting. 

fy.  Tartratis  Antimonii  et  Potassae  iii.  gr. — Tar.  emetic. 
Sul.  Quinine,  xii.  grs. 

Mix  and  divide  into  four  parts.  A  powder  to  be 
given  every  two  hours  during  the  apyrexy,  (intermis- 
sion of  fever,)  it  prevents  the  paroxysm  by  emesis  and 
alvine  evacuations. 

M.  Piorry,  M.  Sculla  Montdezert,  and  M.  Parant  have 
been  advocating  the  use  of  common  salt  in  ague ;  they 
give  one  ounce  of  the  chlorine  of  sodium  in  six  ounces 
of  water,  in  three  doses,  two  hours  before  the  fit.  I 
have  tried  it  in  a  few  cases  only,  and  in  a  majority  of 
which  it  succeeded  beyond  my  expectations. 

M.  Condret  affirms  that  he  cures  intermittent  fever 
effectually  by  dry  cupping.  He  applies  eight  or  ten 
middle  sized  cupping  glasses  on  each  side  of  the  spinal 
column,  from  the  neck  downwards,  and  allows  them  to 
remain  on  about  half  an  hour;  he  applies  them  during 
the  cold  stage,  and  says  two  or  three  applications  are 
sufficient. 

We  are  extremely  sorry  that  we  did  not  possess  Drs. 
King  and  Newton's  invaluable  work  until  most  of  our 
manuscript  was  written;  I  have,  however,  where  I  could 
before  going  to  press,  availed  myself  of  many  valuable 
suggestions  from  their  work.  They  say  that  a  pint  of 
cotton  seed  placed  in  a  quart  of  water,  and  boiled  down 
to  one  pint,  and  one  gill  of  the  warm  tea  given  an  hour 
or  two  before  the  expected  chill,  will  cure  intermittent 


INTERMITTENT  FEVER. 


95 


fever  with  the  first  dose.  It  is  so  simple  a  remedy  it  is 
within  the  power  of  all  to  try.  If  it  should  prove  suc- 
cessful the  South  will  be  under  many  obligations  to 
those  gentlemen ;  they  will  be  viewed  in  the  light  of 
benefactors. 

The  Gdseminum  Sempervirens,  (yellow  jessamine — 
wild  jessamine,)  woodbine,  is  probably  engaging  at  the 
present  time  the  widest  reputation  for  the  cure  of  inter- 
mittent. 

u  The  plant  was  brought  into  notice,  as  far  as  we  can 
learn,  in  the  following  manner :  A  planter,  whose  name 
we  have  forgotten,  having  been  laboring  under  a  severe 
attack  of  bilious  fever,  which  seemed  to  resist  all  reme- 
dial influences,  requested  one  of  his  servants  to  collect 
a  common  root  growing  in  his  garden,  and  prepare  an 
infusion  of  it  for  him  to  drink.  The  servant,  by  mis- 
take, collected  another  root,  and  gave  a  tea  of  it  to  his 
master,  who,  shortly  after  swallowing  some  of  it,  was 
seized  with  a  complete  loss  and  prostration  of  muscular 
power,  unable  to  move  a  limb,  or  even  raise  his  eyelids, 
although  he  could  hear,  and  was  cognizant  of  circum- 
stances transpiring  around  him.  His  friends  collected, 
expecting  every  minute  to  see  him  breathe  his  last. 
After  some  hours,  he  gradually  recovered  himself,  and 
was  astonished  to  find  that  his  fever  had  left  him.  As- 
certaining from  his  servant  what  plant  it  was  which 
acted  in  this  manner,  he  collected  some  of  it,  and  em- 
ployed it  successfully  on  his  own  plantation,  as  well  as 
among  his  neighbors.  The  success  of  this  article  finally 
reached  the  ears  of  some  physician,  who  prepared  from 
it  a  nostrum  called  u  Electrical  Febrifuge,"  which  was 
disguised  with  the  essence  of  wintergreen.  The  plant 
was  the  yellow  jessamine. 


96 


INTERMITTENT  FEVER. 


"Properties  and  Uses. — Narcotic  and  antispasmodic, 
exerting  a  gradual  influence  over  the  system.  The 
resin  of  the  root  is  a  dangerous  poison,  and  care  should 
always  be  had,  in  preparing  the  tincture,  that  the  alco- 
hol be  considerably  diluted.    Those  who  have  used  the 
6  Electrical  Febrifuge,'  among  whom  are  several  physi- 
cians, speak  well  of  it  in  all  species  of  fevers,  nervous 
and  bilious  headache,  colds,  pneumonia,  hemorrhages, 
leucorrhea,  chorea,  ague-cake,  and  several  other  diseases, 
though  it  is  in  -fevers  especially  in  which  its  efficacy  has 
been  mostly  observed.  It  is  said  by  some  to  be  the  only 
agent  ever  yet  discovered  capable  of  subduing,  in  from 
two  to  twenty  hours,  and  without  the  least  possible 
injury  to  the  patient,  the  most  formidable  and  most 
complicated,  as  well  as  the  most  simple  fevers  incident 
to  our  country  and  climate,  quieting  all  nervous  irrita- 
bility and  excitement,  equalizing  the  circulation,  pro- 
moting perspiration,  and  rectifying  the  various  secre- 
tions, without  causing  nausea,  vomiting  or  purging,  and 
is  also  adapted  to  any  stage  of  the  disease.   It  may  fol- 
low any  preceding  treatment  with  safety.    Its  effects 
are  clouded  vision,  double  sightedness,  or  even  complete 
prostration,  and  inability  to  open  the  eyes,  and  which 
gradually  pass  off  in  a  few  hours,  leaving  the  patient 
refreshed,  and  completely  restored.   And  as  soon  as  the 
heaviness  or  partial  closing  of  the  eyes  is  induced,  no 
more  of  the  remedy  will  be  necessary,  although  these 
effects  should  even  follow  the  first  dose. 

"  The  tincture  is  the  preparation  more  generally  em- 
ployed. It  is  made  by  bruising  the  green  roots,  after 
having  cleansed  them,  and  then  filling  a  glass  jar,  keg 
or  barrel  with  them;  then  fill  the  vessel  containing 
them  with  three  parts  of  whiskey,  and  one  part  of  water. 


INTERMITTENT  FEVER. 


97 


After  standing  ten  or  twelve  days,  filter  and  bottle  for 
use.  The  dose  is  from  ten  to  fifty  drops,  in  a  wine  glass 
half  full  of  water,  to  be  repeated  every  two  hours;  the 
second  dose,  in  the  majority  of  cases,  usually  effecting 
the  cure.  From  two  to  ten  grains  of  quinine,  according 
to  the  severity  and  character  of  the  disease,  should  ac- 
company each  dose,  or  it  is  said  the  system  will  relapse 
again  into  the  febrile  state,  in  a  few  hours,  for  want  of 
tonicity  following  the  relaxation  produced  by  the  reme- 
dy. The  original  discoverers  of  the  use  of  the  article 
say,  however,  that  the  quinine  is  not  actually  necessary, 
but  that  its  addition  renders  the  cure  more  prompt,  and, 
by  this  combination,'  its  usual  unpleasant  effects,  as  de- 
termination to  the  head,  &c,  are  completely  obviated. 
When  the  fever  does  not  yield  in  six  hours,  a  mild  pur- 
gative may  be  administered,  or  poclophyllin  in  small 
doses,  may  be  added  to  the  medicine;  if  diarrhoea  be 
present,  add  an  opiate  to  it.  If  one-half  of  the  virtues 
reported  to  exist  in  this  plant  are  true,  it  is  certainly 
deserving  the  close  investigation  of  all  classes  of  physi- 
cians." 

A  very  favorite  recipe,  and  one  which  I  have  used 
with  considerable  success  was, 

fy.    Quinine,  5ss. 
Cream  of  tartar,  gi. 
Cloves  in  powder.  gi. 
Whiskey,  (good)  1  pint. 
Macerate  for  24  hours,  and  filter. 
Dose,  for  an  adult  half  a  fluid  oz.  every  hour  during 
the  intermission,  until  two  or  three  hours  previous  to 
the  time  for  the  return  of  the  chill,  when  it  should  be 
given  every  half  hour.    The  dose  for  children  is  from 
one  to  two  fluid  drachms. 


98 


REMITTENT  FEVER. 


REMITTENT  FEVER. 

Character. — This  fever  in  its  symptoms  suffers  regular 
exacerbations  and  remissions,  but  no  perfect  intermission. 
In  its  nature  it  partakes  both  of  intermittent  and  con- 
tinued fever ;  I  might  assert  that  it  is  essentially  the 
same  as  intermittent  fever.  We  have  only  remissions, 
not  intermissions;  the  disease  is  certainly  continued 
although  remitting.  It  is  particularly  confined  to  warm 
climates. 

Symptoms. — In  its  forming  stage  it  is  very  analogous 
to  those  of  intermittents.  There  is  generally  continual 
fever,  every  day,  throughout  the  twenty-four  hours ;  in 
the  course  of  the  same  a  remission  of  these  symptoms 
generally  takes  place,  but  after  a  short  remission  the 
febrile  symptoms  appear  again,  and  after  a  certain  period 
again  suffer  more  or  less  remission.  This  description 
answers  generally  to  the  mild  form  of  the  disease.  Some- 
times, in  addition  to  the  continual  fever,  there  is  a  regu- 
lar paroxysm  of  ague.  I  have  seen  patients,  and 
especially  in  this  climate,  complain  of  being  extraordi- 
narily warm  day  and  night,  except,  perhaps,  every  other 
day,  when  they  would  have,  probably,  a  chilly  sensation, 
after  which  the  heat  becomes  more  violent,  and  a  slight 
sweating  stage  comes  on  soon  after,  but  when  this  ceases 
their  seems  to  be  no  intermission,  for  the  patient  soon 
becomes  hot  again.  When  the  disease  is  fully  developed 
there  are  pains  in  the  head,  back  and  lower  extremities, 
a  yellow  tinge  of  the  eyes,  considerable  nausea,  some- 
times bilious  vomiting,  fullness  and  tension  in  the  region 
of  the  heart,  pulse  full,  frequent  and  inclining  to  be  soft, 
tongue  coated,  generally  at  first  white,  afterwards  brown, 
with  a  very  bitter  taste  in  the  mouth.    The  mind  is 


REMITTENT  FEVER. 


99 


seldom  affected ;  there  is  at  times  wandering  during  the 
exacerbations,  and  occasionally  we  meet  active  delirium. 
We  sometimes  have  stupor,  but  it  is  generally  not  of  long 
duration,  and  like  delirium  does  not  exist  as  a  prevailing 
feature.  "  In  those  cases  which  have  been  styled  hepatic 
remittent  there  is  an  absence  of  bile  in  the  matters 
evacuated,  whether  by  vomiting  or  stool,  until  towards 
the  close  of  the  attack,  when  there  are  large  evacuations 
of  dark,  pitch-like  matter,  which  have  been  regarded  as 
critical."  For  myself,  I  can  only  assert,  that  I  view 
such  discharges  as  the  most  favorable  omen,  and  during 
the  course  of  my  practice  I  do  not  recollect  one  solitary 
case  that  did  not  recover  when  such  evacuations  were 
established.  It  is  true  they  have  a  very  depressing  in- 
fluence at  the  time,  and  the  patient  has  every  appear- 
ance of  sinking,  but  in  a  short  time  his  system  reacts, 
and  he  is  more  vigorous  than  he  was  before  the  discharges 
commenced.  As  I  before  said,  I  do  not  recollect  one 
solitary  exception  to  this  rule. 

Remote  Cause. — This  form  of  fever  is  produced  by 
certain  irritating  and  depressing  causes.  Miasma  gene- 
rally has  the  greatest  tendency  to  produce  remittent 
fever.  My  own  impression  is,  that  it  acts  upon  the 
solids,  it  is  soon  transferred  into  the  blood  vessels,  and 
its  peculiar  influence  is  conveyed  through  the  nervous 
system,  which  generally  produces  muscular  debility,  and 
when  we  find  the  heart's  action  rapid  it  is  almost  inva- 
riably the  result  of  depression  of  the  nervous  system. 
The  excretions  and  secretions  are  all  perverted  in  quality. 
We  have  a  feeble  appetite,  the  surface  is  generally  hot, 
the  blood  is  acted  upon  from  the  foreign  poison  which 
emanated  from  the  solids ;  the  depression  is  after  a  time 
followed  by  reaction,  which  is  the  first  of  the  hot  stage. 


100 


REMITTENT  FEVER. 


The  blood  having  receded  from  the  surface  and  congested 
itself  in  the  internal  organs,  when  re-action  does  take 
place  it  is  a  powerful  assistant  to  aggravate  the  fever, 
a; id  the  blood  being  in  a  morbid  condition,  it  adds  its 
influence  in  irritation  to  the  heart.  In  the  cold  stage, 
as  I  before  observed,  the  blood  is  all  accumulated  in  the 
internal  organs,  which  of  course  have  all  been  in  a  state 
of  congestion,  and  when  reaction  does  take  place,  inflam- 
mation is  already  exhibited  from  the  turgescence  in 
which  the  blood  vessels  have  been  in.  In  eruptive  dis- 
eases the  blood  generally  becomes  secreted  in  the  capil- 
lary vessels,  when  inflammation  is  soon  jDroduced  from 
the  congestion.  Inflammation  is,  therefore,  the  great 
cause  of  death  in  idiopathic  fevers.  We  sometimes  have 
inflammation  surviving  the  cure,  as,  for  instance,  the 
spleen  in  autumnal  fever.  In  the  secreting  or  decline 
of  the  hot  stage,  which  is  the  stage  of  returning  health, 
the  vital  powers  are  recovering,  and  you  will  have  secre- 
tions from  the  different  parts,  and  our  patient  will  be 
much  better  if  they  are  abundant ;  we  must  assist  them 
when  the  excitement  of  the  system  is  allayed,  and  not 
before,  if  you  do  you  will  increase  the  irritation  and  do 
no  good.  It  is  an  established  principle  that,  if  the  regu- 
lar secretions  are  disturbed  the  individual  will  soon  be 
unwell ;  this  will  bring  on  fever,  and  it  may  be  the 
cause  of  producing  mflammation  in  some  part  of  the 
system. 

Etiology. — We  extract  from  the  prize  essay  of  Pro- 
fessor L.  P.  Yandell  his  views  in  regard  to  the  cause  of 
this  fever.  We  do  this  from  the  satisfaction  of  knowing 
personally  the  high  character  and  elevated  position  that 
that  gentleman  occupies  in  the  medical  world.  His 
opinions  have  great  weight,  and  are  entitled  to  the 


REMITTENT  FEVER. 


101 


greatest  confidence.  "  Nothing  in  regard  to  bilious  fever 
is  better  settled  than,  that  the  poison  which  generates  it 
is  developed  by  the  drying  up  of  ponds  and  water 
courses,  in  a  fertile  region  of  country,  under  an  ardent 
summer  and  autumnal  sun.  Wherever  moisture  is  pre- 
sent to  co-operate  with  organic  matter  in  warm  weather, 
there  is  decomposition  going  on  and  there  is  found  bilious 
disorder,  especially  by  the  bottoms  of  streams  or  ponds 
recently  exposed  to  the  air  and  the  sun,  does  the  poison  ' 
of  fevers  seem  to  be  ehminated.  The  draining  of  a  mill 
pond,  if  done  late  in  the  summer  or  in  the  fall,  hardly 
ever  fails  to  spread  miasmatic  diseases  far  and  wide 
among  the  inhabitants  of  the  neighborhood.  The  fol- 
lowing is  an  instance  in  point,  which  has  never  been 
published :  The  proprietor  of  a  mill  on  a  small  stream 
in  Ohio,  was  in  the  habit  every  year  in  early  summer, 
when  the  waters  became  low,  of  draining  the  pond  by 
raising  the  flood-gate.  No  injury  to  the  health  of  his 
neighbors  resulted  so  long  as  the  draining  process  was 
confined  to  early  summer.  The  inhabitants  of  a  village 
bordering  upon  the  stream  were  not  particularly  subject 
to  fevers,  but  during  a  wet  summer  in  1839,  as  the 
stream  continued  full,  he  was  induced  to  postpone  drain- 
ing the  pond  until  late  in  August ;  the  consequence  was 
that  a  most  formidable  fever  broke  out  in  the  village, 
and  prevailed  to  an  extent  before  unknown  in  it.  The 
owner  of  the  mill  was  compelled  to  draw  off  the  water 
next  spring,  the  pond  having  been  condemned  as  a 
public  nuisance,  and  the  summer  which  followed  was 
one  of  health  in  all  of  the  surrounding  neighborhood." 

As  regards  the  duration  of  bilious  remittent  fever,  it 
varies  in  accordance  with  the  intensity  of  the  attack  in 
the  simple  uncomplicated  character.  In  this  climate,  with 


102 


REMITTENT  FEVER. 


proper  treatment,  it  generally  terminates  in  a  few  days, 
and  our  most  violent  cases  seldom  exceed  nine  days. 
There  are  some  cases  which  from  their  violence  have  a 
malignant  tendency,  and  such  cases  are  generally  very 
tedious.  Dr.  Dickson,  of  South  Carolina,  says,  "it  is  not 
uncommon,  especially  among  the  most  perfectly  accli- 
mated adult  natives  resident  in  malarious  localities,  and 
strangers  long  familiarized  to  them,  to  find  bilious  remit- 
tent fever  of  very  protracted  duration,"  "and  terminating 
generally  after  the  twelfth  day  in  a  low  form  or  typhoid 
stage  of  bilious  fever.  In  this  climate  such  cases  are 
very  rare.  My  friend,  Dr.  Rogers  of  Chappell  Hill,  and 
some  other  medical  gentleman  of  the  Brazos  Valley,  have 
assured  me,  however,  that  in  their  districts  this  form 
was  quite  common." 

Hepatic  Modification. — The  most  severe  and  dangerous 
form  of  this  disease  is  soon  known  by  the  great  febrile 
heat  during  the  exacerbations,  fullness,  tension  and 
pulsation  in  the  right  side,  delirium,  tongue  foul;  and 
great  irritability  of  the  stomach  accompanied  by  severe 
vomiting.  The  discharges  from  the  bowels  are  of  various 
colors  and  consistence,  sometimes  obstinately  constipated 
to  a  great  degree,  at  other  times  the  discharges  are  green 
or  black. 

Genei^al  Indications  of  Cure  m  Fever. — Some  are  self- 
limited,  and  consequently  it  is  very  difficult  to  shorten 
them,  but  the  reverse  can  be  effected.  In  small-pox  you 
cannot  prevent  the  fever,  but  you  may  keep  it  from  dis- 
organizing the  system  and  save  your  patient's  life.  There 
are  a  great  many  practitioners  who  never  attempt  to 
relieve  the  paroxysm  until  the  system  is  prepared  for 
the  specific  or  tonics.  The  first  indications  are  to  mode- 
rate the  action  of  the  heart  and  arteries ;  to  remove  the 


REMITTENT  FEVER. 


103 


irritating  contents  of  the  bowels,  and  moderate  intestinal 
irritation ;  to  restore  the  healthy  functions  of  the  liver. 
To  answer  all  of  these  indications  we  employ  the  tinct. 
aconite  to  relieve  the  arterial  excitement.  Bleeding  is 
but  seldom  necessary  in.  the  milder  cases  of  remittents, 
it  is  a  favorite  with  some ;  it  might  become  necessary 
when  the  pulse  is  full,  vigorous  and  hard,  the  skin  very 
hot  and  dry,  and  the  headache  intense  and  acute ;  but 
even  under  these  circumstances  the  lancet  should  always 
be  employed  by  a  sound  judgment  and  with  great  caution. 
The  first  indication  would  be  to  moderate  the  heart's 
action  and  reduce  the  vascular  system.  Every  case  of 
fever  will  present  morbid  action  in  the  heart  and  blood 
vessels,  but  does  not  present  power  in  every  instance. 
In  typhoid  and  autumnal  fevers  the  powers  are  gene- 
rally in  excess.  We  will  introduce  the  means  to  reduce 
the  action.  You  must  withdraw  every  stimulant  from 
him ;  he  must  have  a  cool  and  fresh  air  ;  you  must  ab- 
stract the  caloric  from  his  body ;  you  must  look  to  what 
acts  upon  the  organ  of  sense ;  you  must  diminish  light 
and  noise,  and,  in  fact,  every  stimulant  must  be  with- 
held ;  you  must  look  well  to  his  alimentary  canal,  (the 
bowels,)  and  see  if  there  is  any  feculent  matter,  from 
the  peristaltic  motion  not  being  in  health,  you  must, 
consequently,  if  there  is  any  obstruction  or  irritating 
matter,  it  must  be  removed  by  cathartics ;  the  mental 
influences  must  be  attended  to ;  he  must  not  engage  in 
any  thing  that  will  excite  the  brain,  &c.  If  there  is 
vascular  action  it  must  be  moderated.  You  will  carry 
off  the  contents  of  the  stomach  and  alimentary  canal, 
but  you  must  not  endeavor  to  increase  the  secretions 
immediately.  If  the  pulse  is  full,  tense  and  bounding 
you  will  find  the  aconite  will  lessen  its  volume,  and 


104 


REMITTENT  FEVER. 


therefore  lessen  the  chances  to  inflammation  from  con- 
gestion. There  is  another  means  which  will  deplete, 
which  must  not  be  neglected,  by  exciting  the  secretions 
which  lessen  the  vascular  action,  hence  you  produce 
nausea ;  it  is  valuable  and  must  not  be  neglected.  If 
you  should  resort  to  the  lancet  it  should  always  precede 
purging ;  you  will  deplete  from  the  kidneys ;  you  will 
give  nitrate  of  potash,  cream  of  tartar,  &c.  You  like- 
wise deplete  from  the  skin  by  giving  minute  doses  of 
tartarized  antimony,  but  a  more  favorite  remedy  with 
me  is  Beach's  sudorific  tinct. ;  these  are  medicines  which 
cool  the  system.  The  vegetable  acids  are  celebrated  for 
their  uses  in  fever ;  they  do  not  stimulate  the  heart,  but 
reduce  the  energy  of  the  calorific  functions.  Tartarized 
antimony  stands  very  high  in  a  direct  effect  in  de- 
creasing arterial  action,  but  should  be  used  with  great 
caution,  when  you  give  cathartics.  With  antimonials 
you  will  relieve  the  action  of  the  heart  and  de}3lete  more 
successfully  in  inflammatory  fevers  than  any  other. 

The  next  thing  is  to  consider  the  morbid  action,  and 
to  alter  its  mode.  The  acetous  emetic,  which  we  will 
lay  down,  fulfils  several  indications  to  change  morbid 
action.  Podophylline  is  another  remedy,  and  is  bene- 
ficial in  inflammatory  fevers  if  preceded  by  the  remedies 
above  alluded  to;  another  is  the  sulphate  of  quinine; 
it  will  produce  a  constitutional  effect,  and  acts  as  a 
sedative  in  proper  doses. 

The  next  consideration  is  the  depuration  of  the  blood; 
it  undergoes  changes  in  disease,  and  we  must  purify  that 
fluid;  a  copious  perspiration,  if  it  can  be  kept  up,  is 
always  likely  to  be  beneficial,  and  if  copious,  fever  will 
abandon  the  system.  Such  medicines  that  will  produce 
great  secretions  of  the  liver,  generally  are  of  great  consi- 


REMITTENT  FEVER. 


105 


deration  in  producing  a  copious  termination  to  the  sur- 
face. In  all  the  diseases  of  the  South  there  is  generally 
great  biliary  derangement ;  therefore,  it  is  that  Podo- 
phylline  and  some  medicines  act  so  beneficially  in  pro- 
ducing healthy  action  of  the  blood,  by  relieving  biliary 
endorsement  of  the  liver.  I  would  here  remark  that, 
whilst  you  are  giving  cathartics,  to  deplete  the  alimen- 
tary canal,  it  is  difficult  to  produce  perspiration  at  the 
same  time,  consequently  the  latter  should  be  attempted 
after  purging.  I  frequently  resort  to  it,  however,  be- 
fore. I  generally  use  spirit  us  mindererus,  or  Dover's 
Powders,  on  the  sudorific  tincture.  If  the  patient's 
stomach  be  very  irritable,  you  will  be  better  able  to 
remove  foreign  substances  by  giving  a  light  emetic; 
if  you  resort  to  this,  use  the  emetic  powder.  I  should, 
however,  be  very  careful  not  to  administer  an  emetic  if 
the  pulse  was  full,  which  would  indicate  a  slight  inflam- 
mation ;  if  you  found  any  soreness  upon  the  epigastric  re- 
gion from  pressure,  you  should  not  administer  an  emetic, 
or  at  least  be  careful  in  it.  If  you  find  soreness  upon 
percussion,  you  would  not  attempt  to  administer  it. 
Ipecac.  I  always  add  to  the  emetic  powder;  it  is  my  fa- 
vorite in  this  fever.  I  would  here  caution  you  against 
pushing  cathartics  too  far;  3-ou  can  produce  such  an 
irritation  in  the  alimentary  canal  as  will  terminate  in 
inflammation,  and  I  have  frequently  seen  instances 
where  purging  was  the  cause  alone  of  changing  the  color 
of  the  tongue  to  a  very  bad  appearance. 

Antimonial  preparations  sometimes  change  the  dia- 
thesis in  this  disease ;  mercury  will  sometimes  change 
its  type,  but  we  must  confess  that  we  are  a  poor  advo- 
cate for  its  use ;  we  think,  in  a  large  majority  of  cases, 
that  Podophylline  fulfils  all  its  indications.    Quinine  is 


106 


REMITTENT  FEVER. 


a  very  valuable  remedy,  but  if  administered  in  small 
doses,  when  the  patients  pulse  is  excited,  it  increases 
the  arterial  excitement ;  but  if  administered  in  ten  grain 
doses,  it  will  certainly  act  as  a  sedative. 

The  indication  to  be  filled  in  Remittent  is  to  bring  it 
in  the  same  state  that  we  have  in  intermittent,  and  this 
is  to  be  done  by  the  general  treatment  already  pointed 
out.  We  cannot  administer  safely  the  quinine  when 
there  is  inflammation  of  the  alimentary  canal,  or  great 
irritability  of  the  stomach,  but  when  this  is  not  the 
case,  we  may  begin  its  use  at  a  very  early  period  with 
benefit.  Cases  are  reported  where  quinine  alone  has 
been  the  remedy,  and  the  patient  cured  in  a  short  time. 
If  such  be  the  fact,  why  subject  a  patient  to  a  course  of 
debilitating  remedies;  this  would  be  a  very  hazardous 
practice.  My  own  general  treatment,  however,  is,  after 
having  cleansed  the  alimentary  canal,  and  produced  a 
copious  perspiration,  I  make  a  compound  which  I  give 
every  six  hours  during  the  remission,  which  is  as  fol- 
lows : 

1^.    Podophylline,  1  grs. 

Aloes,  *  2  " 

Quinine,  10  " 

Piperine,  1  " 

Opium,  1  " 

I  frequently  divide  this,  and  administer  it  every  three 
hours.  Some  of  the  following  remedies  I  frequently 
use,  and  can  safely  say,  they  will  seldom  disappoint 
your  expectations. 

The  following  with  us  are  popular : 
3^.    Pulv.  aloes,  Sii. 

Ex.  eupatorium  perfoliatum,  %i — Boneset. 
Castile  soap,  i£. 


REMITTENT  FEVER. 


107 


Ex.  podophylline,  Sss. — May  apple. 

Lobelia  seeds  pulv.  5ii. 

Ex.  gentian.  5ss. 

Pulv.  capsicum,  oii. — Cayenne. 

Oil  cloves,  oi- 
Warm  the  extracts,  and  then  add  the  other  articles; 
mix  intimately,  and  divide  into  five  gr.  pills. 

As  an  aperient,  from  one  to  three  is  sufficient ;  as  an 
art  ire  cathartic  four  to  six.  I  have  frequently  known, 
an  active  dose  of  them,  to  relieve  a  severe  case  of  bilious 
fever. 

I  frequently  use  the  following : 

11.    JVfassae  ex.  hydrg.    di. — Blue  mass. 
Pulv.  Rhei.  x  grs. — Rhubarb. 

Sul.  quinine,  5ss. 
Mix  intimately,  and  divide  into  twelve  pills;  give 
one  every  hour,  or  two  every  two  hours. 

The  following  is  well  calculated  to  prepare  the  ali- 
mentary canal  for  other  remedies : 

R."   Pulv.  Rhei.  —Rhubarb. 
Saponis  albi,      aa.  5^s. — Castile  soap. 
Podophyllin,  v  grs. — Resenous   principle  of 

Mandrake. 
Simple  syrup,     q.  s. — Sufficient  quantity. 
Mix  and  divide  into  fifteen  pills;  give  one  every  two 
hours. 

In  the  high,  or  malignant  grades  of  this  disease,  from 
the  engorgement  and  inactive  state  of  the  hepatic  sys- 
tem, emetics,  emeto-cathartics,  and  strong  purgatives, 
useful  in  the  commencement  of  the  milder  forms  of  the 
disease,  are  altogether  inadmissible.  The  first  object  is 
to  allay  gastric  irritability,  which  is  generally  very 
great.    For  this  purpose,  when  there  is  congestion  or 


108 


REMITTENT  FEVER. 


engorgement,  the  local  abstraction  of  blood  by  cupping- 
is  the  most  important  measure ;  sinapism  to  the  stomach, 
and  warm  bath  after  cupping. 

We  proceed  to  give  from  our  memorandum  book  two 
cases  in  detail,  so  that  our  treatment  in  general  cannot 
be  misapplied. 

Case  1st.  I  was  called  on  the  night  of  the  12th  Au- 
gust, 1851,  to  Mrs.  H.  She  had  been  taken  a  day  or 
two  before  with  headache  and  dull  chill;  the  headache 
continued,  with  a  general  feeling  of  prostration,  and  to- 
wards evening  became  more  severe,  accompanied  by 
great  heat  and  thirst,  with  pain  in  the  back  and  bones. 

13th.  Pain  in  the  head  severe,  face  flushed,  tongue 
yellow,  pain  in  the  back  very  acute,  skin  hot  and  dry ; 
pulse  ninety-eight,  full  and  strong.  We  gave  a  few 
drops  of  tinct.  aconite,  repeated  at  short  intervals,  until 
the  arterial  action  was  subdued,  when  two  pills  of  the 
following  prescription  were  ordered  every  two  hours 
until  they  operated  well. 
1^.  Pulv.  jalap. 
 rhubarb. 

Saponis  albi,  (soap,)        aa.  9i. 

Podophylline,  v  grs. 

Pulv.  ipecac,  v  " 

To  be  made  into  sixteen  or  twenty  pills. 
14th.  The  aconite  relieved  the  headache  yesterday, 
but  to-day  the  cephalalgia  is  about  the  same  as  yester- 
day, flushed  face,  tongue  as  before  described ;  consider- 
able tenderness  over  the  region  of  the  stomach,  skin 
hot  and  dry,  no  perspiration  up  to  this  time,  pulse  nine- 
ty-two, full,  yet  more  compressible  than  yesterday ;  four 
cups  were  placed  over  the  stomach,  considerable  consti- 
pation; pills  continued,  and  one  drachm  of  spirits  min- 


REMITTENT  FEVER. 


109 


dererus  (solution  of  acetate  of  ammonia)  every  hour 
and  a  half  until  perspiration  was  produced. 

15th.  Eyes  heavy  and  injected;  considerable  prostra- 
tion; perspired  after  the  administration  of  the  minde- 
rerus  freely,  tongue  still  very  yellow;  the  cups  relieved 
the  pain  in  the  stomach;  pulse  ninety-eight,  and  soft; 
urine  very  high  colored,  and  depositing  a  sediment. 
Blue  pill  three  grs.,  quinine  six  grs.,  were  ordered  every 
five  hours. 

16th.  Has  taken  three  doses  of  blue  pill  and  quinine; 
three  or  four  bilious  stools;  pulse  eighty-five,  soft  and 
full;  perspiration  night  and  day. 

17th.  At  twelve  o'clock  in  the  day,  yesterday,  recur- 
rence of  the  fever,  skin  hot  and  dry;  the  quinine  was 
discontinued  on  the  appearance  of  the  fever,  as  well  as 
beef  tea  which  she  had  been  taking.  The  fever  conti- 
nued during  the  afternoon,  pulse  ninety,  skin  hot  and 
dry ;  it  gradually  went  off,  and  the  quinine  was  resumed 
with  three  pills  composed  of  equal  parts  of  aloes,  rhu- 
barb and  quinine. 

On- the  following  morning  the  pulse  and  skin  had  be- 
come natural,  the  bowels  had  been  freely  opened;  qui- 
nine and  tea  were  continued,  and  hi  a  few  days  the 
patient  was  convalescent. 

Case  2d. — I  was  called  on  the  3d  September,  1851,  to 
visit  Master  G.  His  intelligence  was  dull,  tongue  furred, 
prostration  great,  profuse  cold  perspiration,  bowels  very 
costive.  An  active  cathartic,  composed  of  scammony 
and  podophylline  was  ordered,  and  repeated  three  times 
without  producing  any  stool. 

4th.  Could  scarcely  be  aroused,  headache  severe, 
tongue  covered  with  a  thick  yellow  fur.  I  ordered  the 
same  cathartic,  increased  in  combination  with  castor  oil; 


110 


REMITTENT  FEVER. 


I  was  soon  requested  to  return,  as  he  was  having  fits 
rapidly ;  I  fount!  him  with  a  fit  on ;  the  temporal  artery 
was  opened,  and  considerable  quantity  of  blood  taken. 
I  had  ordered  injections,  they  did  nothing;  medicine 
had  not  as  yet  operated ;  the  bleeding  had  allayed  spas- 
modic action.  A  large  dose  of  scammony,  gamboge, 
and  calomel  was  now  ordered ;  waited  eight  hours  and 
no  operation.  I  then  ordered  one  drop  of  Croton  oil, 
and  one  gr.  tartarized  antimony ;  in  a  few  hours  he  had 
three  copious  stools. 

5th.  Prostration  very  great,  the  arms  were  allowed  to 
fall  like  a  dead  weight,  his  skin  hot,  stupor  profound.  I 
gave  spirits  mindererus,  and  we  soon  had  a  profuse  per- 
spiration over  the  whole  body,  pulse  soft  and  weak; 
four  grains  of  quinine  every  hour,  and  a  blister  to  the 
nape  of  the  neck. 

6th.  His  lethargy  was  aroused  in  a  few  hours  after 
the  blister  was  applied;  pulse  eighty-eight,  soft  and 
compressible;  continued  quinine  treatment.  At  three 
o'clock  cold  perspiration,  cold  extremities,  and  deep  som- 
nolency; heat  was  applied  (warm  ashes)  to  the  extremi- 
ties; quinine  was  given  in  combination  with  brandy, 
and  blistered  extensively. 

7th.  Very  much  prostrated;  quinine  and  camphor  in 
four  grain  doses  every  two  hours;  a  pill  of  the  mass 
every  four  hours,  with  small  portions  of  ipecac.  From 
this  time  he  rapidly  improved,  and  was  soon  convales- 
cent. 

We  have  only  spoken  of  blisters  to  the  back  of  the 
neck ;  their  application  to  many  other  parts,  in  irritation 
and  oppression,  are  of  great  practical  utility ;  in  inflam- 
matory cases  they  may  prove  more  annoying  than  use- 


REMITTENT  FEVER.  Ill 

fill;  the  local  abstraction  of  blood  is  generally  more 
preferable,  and  at  least  should  precede. 

We  have  given  two  cases  only  from  their  peculiarity. 
We  have  tried  to  make  our  general  treatment  explicit, 
and  will  proceed  to  lay  down  the  remedies  which  we 
have  alluded  to  under  this  head,  and  which  remedies 
possess  our  confidence;  and  we  would  especially  refer 
you  to  the  recipe  of  an  anti-bilious,  pill  laid  down  under 
the  head  of  intermittent  fever. 

A  favorite  cathartic  with  me  is  the  following : 
R.    Podophylline,     ii  grs. — Mandrake. 
Cream  of  tartar,  5iii. 

To  make  it  stimulating  add  half  a  scruple  of  capsi- 
cum (cayenne  pepper) ;  mix  all  the  ingredients  inti- 
mately, and  divide  into  eight  doses;  give  one  every  two 
hour.-. 

The  acetous  mixture,  which  has  been  alluded  to,  con- 
sists of: 

Sanguinaria — Blood  root. 
Lobelia  seeds. 

Ictodes  foetida,  (skunks  cabbage  root.)  aa.  5iss,  pulv. 
Good  cider  vinegar  one  quart. 

Mix  and  let  it  digest  in  a  warm  place  for  a  week  ; 
strain  and  press  the  dregs. 

Dose,  one  drachm  every  ten  or  fifteen  minutes,  increas- 
ing it  up  to  four  or  five,  until  the  desired  effect  is  pro- 
duced; to  be  given  in  sage  tea. 

Beach's  sxulorific  tincture  is  a  valuable  remedy;  the 
recipe  is  as  follows : 
Ipecac. 

Gum  camphor. 

Serpt.  virg. — Virginia  snakeroot. 
Opium,  aa.  5ii. 

Proof  spirit,  (he  uses  gin,)  3  qts. 


112 


REMITTENT  FEVER. 


31ix  and  digest  for  two  or  three  weeks.  Dose,  i  to  5i, 
to  be  given  in  some  warm  infusion.  We  have  some  ob- 
jection to  this  recipe  on  account  of  the  opium,  and  we 
'frequently  substitute  for  it  cypripedium  pubescens  5vi, 
(yellow  lady's  slipper,)  and  flatter  ourselves  that  it  is  a 
good  substitute,  answering  all  the  purposes,  without  the 
stupefying  effects  which  follow  the  opium. 

Anodynes,  when  the  patient  is  extremely  restless  and 
wakeful,  may  be  given  with  benefit,  and  you  will  gene- 
rally find  "Dover's  powders"  beneficial.  I  cannot  close 
this  subject  without  referring  to  the  practice  of  applying 
blisters,  as  well  as  mustard  plasters,  in  almost  every  va- 
riety of  fever;  as  a  general  rule  they  should  be  dis- 
pensed with,  yet  in  some  severe  cases  I  have  frequently 
given  relief  by  applying  a  large  one  over  the  region  of 
the  liver;  the  benefit  depends  upon  the  stimulus  it  im- 
parts to  this  organ.  Some  of  my  medical  friends  inform 
me  they  have  applied  them  below  the  shoulder  with 
similar  success,  and  my  friend  Dr.  W.  S.  Rogers  assures 
me  he  has  frequently  done  much  good  by  mustard  ajDpli- 
cations  at  this  point. 

As  soon  as  a  state  of  convalescence  f  manifests  itself, 
the  patient  should  use  great  precaution  and  care  to 
prevent  a  relapse;  his  diet  should  be  vegetable,  and 
spare. 

We  append  at  the  close  of  this  subject  some  remedies 
which  we  have  employed  in  practice,  and  w^hich  have 
generally  met  our  expectations. 

fy.    Nitrate  of  potassa,  3iss. 
Mucilage  of  gum  acaciae,  f.  §ii. 
Antimonial  wine,        gtts.  xl. — (Drops). 
Syrup  orange  peel,  gss. 
Water,  %iv. 


REMITTENT  FEVER. 


113 


Mix;  give  one  oz.  three  times  a  clay  in  remittent  fever 
with  a  hot  skin. 

As  a  cooling  drink  in  fevers,  we  frequently  recom- 
mend either  of  the  following  recipes. 

fy.    Vinegar,  5  hi. 

Honey,  Sii- 
Water,  3  pints. 

Mix;  drink  acl  libitum,  as  much  as  they  want,  or, 
I$5.    Vinegar,  Si. 
Acetic  ether,  5h 
Syrup  raspberries,  Biii. 
Water,  1  quart. 

Mix;  use  as  above. 

It  is  frequently  essential  in  this  fever  to  produce  dia- 
phoresis, without  disturbing  the  patient.  It  may  be 
effected  as  follows : — Take  a  piece  of  lime  about  the  size 
of  a  lemon,  wrap  around  it  a  wet  rag,  but  not  too  wet; 
around  this  wrap  several  thicknesses  of  dry  muslin  or 
cloth;  place  one  thus  prepared  on  each  side  of  the  pa- 
tient, and  by  both  thighs;  it  will  soon  induce  copious 
perspiration. 

Dr.  Jones,  of  Cincinnati,  has  used,  with  immense  suc- 
cess the  ferrocyanuret  of  ferri,  (prussiate  of  iron) ;  he 
does  not  regard  febrile  or  inflammatory  symptoms  in  its 
administration,  provided  the  disease  be  in  the  least  degree 
periodical;  he  gives  it  in  doses  of  three  or  four  grains 
every  three  or  four  hours,  in  combination  with  quinine. 
It  is  a  remedy  we  have  long  used,  and  one  that  I  have 
great  faith  in.  , 

Our  last  remedy  for  intermittent  fever  is  highly  prized 
by  some  physicians  in  remittent  fever,  and  others  extol 
the  jessamine  equally  as  much. 
8 


114 


CONTINUED  FEVER. 


CONTINUED  FEVER. 

Definition. — The  same  variety  of  symptoms  which 
occur  in  intense  local  inflammation  are  those,  most  gene- 
rally, which  will  be  observed  in  this  fever.  In  this 
climate  we  frequently  have  the  same  symptoms  which 
present  in  intermittent  fever.  This,  however,  is  in  di- 
rect opposition  to  Professor  Andral,  who  says,  "  chilli- 
ness rarely  occurs."  I  have  been  peculiarly  attentive  to 
this  circumstance,  and  have  noticed  their  analogy  to 
intermittent  fever.  This  class  of  symptoms,  it  is  true, 
are  of  short  duration ;  they  soon  yield  to  those  of  excite- 
ment, and  these,  in  a  very  large  majority  of  cases, 
continue  throughout  the  disease,  and  are  frequently 
accompanied  with  great  debility. 

Symptoms. — The  symptoms  vary  considerably  in  their 
general  character.  There  is  quickness  of  pulse,  in- 
creased heat,  and  diminution  of  the  secretions  usually; 
we  have  these  symptoms  in  combination  with  thirst, 
great  dryness  of  skin,  scanty  and  high  colored  urine, 
with  considerable  costiveness.  At  first,  or  beginning 
of  the  attack,  we  have  chilliness  amounting  almost 
to  rigors,  with  paleness  and  smallness  of  pulse,  but  these 
generally  last  only  for  a  short  time.  It  is  attended  with 
affection  of  the  head,  at  first  more  or  less  confusion,  at 
times  great  giddiness ;  there  is  always  a  perfect  loss  of 
appetite  and  a  general  sense  of  debility,  whiteness  and 
dryness  of  the  tongue,  great  uneasiness  of  the  limbs, 
occasioning  frequent  change  of  posture ;  extreme  irrita- 
dility  of  the  sense  of  sight  and  hearing,  especially  in 
persons  of  irritable  constitutions;  any  noise  is  almost  in- 
supportable. The  fever  is  generally  formed  in  the  course 
of  the  first  evening,  and  the  hot  stage  frequently  is  de- 


CONTINUED  FEVER. 


115 


veloped  in  an  hour  or  less.  Vomiting  is  seldom  present, 
at  least  till  the  third  day  ;  frequently  no  sickness  at  the 
stomach,  unless  the  lancet  has  been  resorted  to,  after 
which  it  is  quite  severe.  I  have  seen,  after  two  or  three 
days,  a  tendency  to  delirium,  and  sometimes  I  have  seen 
it  developed ;  it  occurs  most  frequently  before  the  hot 
stage.  "  The  terminations  of  this  form  of  fever  are 
essentially  three  in  number :  abrupt  departure  in  con- 
nexion with  some  critical  discharge,  gradual  mitigation 
and  disappearance  without  particular  increase  of  any  of 
the  excretions  or  any  adventitious  evacuation,  and  gra- 
dual transition  from  the  purely  inflammatory  character 
into  the  typhoid  type." 

The  Pulse. — Their  is  no  certain  diagnosis  to  be  derived 
from  the  examination  of  the  pulse.  We  frequently  find 
it  assuming  every  grade ;  it  may  be  full  or  hard,  -soft, 
small  or  weak ;  it  is  sometimes  so  feeble  as  to  be  called 
fluttering.  The  safest  mode  is  to  examine  the  circula- 
tion at  the  heart.  The  usual  range  of  the  pulse  is  from 
ninety  to  one  hundred  and  sixty. 

State  of  the  Tongue. — The  tongue  is  unusually  dry  in 
this  fever.  We  generally  find  it  yellow  and  loaded,  but 
it  may  be  found  absolutely  black ;  it  assumes,  however, 
a  great  many  varieties. 

The  Stomach. — We  find  as  much  uncertainty  in  regard 
to  this  organ  as  we  find  in  the  pulse;  for  the  most  part 
the  appetite  is  lost,  but- yet  we  see  cases  where  it  is  the 
reverse,  accompanied  by  an  extraordinary  desire  for 
food. 

This  fever  generally  terminates  in  some  manifest 
critical  discharge,  such  as  haemorrhage  from  the  nose 
and  copious  perspiration,  the  most  common.  It  is  most 
apt  to  occur  in  persons  of  a  robust  constitution. 


116 


CONTINUED  FEVER. 


Cause. — "The  most  common  causes  are  :  atmospheric 
vicissitudes,  violent  passions,  wounds  and  other  injuries, 
a  peculiar  atmospheric  constitution.  Sudden  suppression 
of  perspiration  by  cold  is,  however,  the  most  common 
sporadic  cause.  Hence,  inflammatory  fevers  are  most 
prevalent  in  cold  and  variable  climates,  or  during  the 
spring  of  temperate  latitudes ;  more  prevalent  also  in 
elevated,  dry,  and  sandy  situations,  than  in  localities  of 
an  opposite  character." 

Prognosis. — The  simple  inflammatory  fever  is  the  least 
dangerous  variety  of  this  fever ;  when  it  is  attended  with 
abdominal  inflammation  it  is  highly  dangerous.  When 
the  fever  is  greatly  protracted  it  is  very  apt  to  assume 
a  typhoid  character.  A  very  sudden  and  copious  dis- 
charge of  urine,  or  thin  watery  discharges  are  very 
unfavorable.  We  frequently  find  in  cases,  that  have  a 
tendency  to  terminate  favorable,  a  slight  bleeding  from 
the  nose,  a  moist  and  soft  skin.  Pale  urine  a  bad  sign. 
Delirium  not  to  be  considered  dangerous. 

Treatment. — The  first  duty  of  the  physician  is  to  see 
that  the  room  of  the  patient  is  well  ventilated,  and  he 
should  be  particular  in  having  his  patient  washed  all 
over  with  soap  and  water.  After  this,  during  fever,  you 
can  sponge  the  body  with  warm  water,  which  is  not  only 
useful  but  very  grateful  to  your  patient.  If  the  tempe- 
rature of  your  patient  be  above  ninty-eight  I  would  not 
hesitate  to  give  him  the  cold  dash. 

Emetics, — Are  seldom  proper  in  inflammatory  fevers. 
If,  on  making  pressure,  we  find  tenderness  over  any 
portion  of  the  abdomen,  it  would  not  do  to  have  recourse 
to  an  emetic.  If  there  should  be  a  determination  of 
blood  to  the  head  it  would  be  extremely  wrong  to  have 
recourse  to  an  emetic.    In  the  beginning  of  the  fever, 


CONTINUED  FEVER. 


117 


and  in  the  absence  of  the  above  symptoms,  a  grain  of 
tartar-emetic  with  a  scruple  of  ipecacuanha  is  sometimes 
beneficial ;  if  the  pulse,  however,  would  justify  the  use 
of  the  lancet,  I  should  always  premise  bleeding  before 
giving  it.  It  is  in  this  fever  the  lancet,  if  ever  used,  will 
be  found  beneficial. 

Cathartics. — The  bowels  should  be  kept  in  a  mild  and 
soluble  condition,  and  there  should  be  at  least  one  evacu- 
ation every  day.  That  which  is  most  proper  to  remove 
the  constipation  without  debilitating  the  patient  is  to  be 
considered.  Dr.  Eberle  maintains  that  the  saline  ca- 
thartics are  the  best.  I  would  not  question  this  in  a 
cold  climate,  where  there  is  no  relaxation  of  the  general 
tissues,  but  in  the  South,  where  such  medicines  have 
almost  a  universal  tendency  to  produce  violent  hyper- 
catharsis,  which  would  be  very  injurious  in  this  disease, 
I  would  think  such  treatment  would  be  very  question- 
able. My  own  impression  is,  that  in  this  disease  above 
all  others,  calomel  in  combination  or  podophylline  as  an 
alterative  is  the  most  proper.  It  should  be  administered 
according  to  the  amount  of  constipation ;  my  own  prac- 
tice is  to  give  from  five  to  thirty  grains,  waiting  some 
six  or  eight  hours  for  its  operation,  and  then  assisting 
its  action  every  two  hours  by  a  table-spoonful  of  castor 
oil.  Sometimes  it  requires  the  assistance  of  an  injection ; 
this,  however,  is  not  to  be  done  if  the  bowels  be  suffi- 
ciently open  of  themselves.  You  will  sometimes  find 
an  opposite  state  of  the  bowels,  too  open,  then,  of  course, 
the  purgative  plan  will  be  highly  injurious. 

Blood-letting. — If  there  is  a  great  excitement  in  any 
one  organ,  or  general  excitement  of  the  whole  system, 
the  lancet  can  be  safely  used  ;  but  there  is  no  question 
but  the  instrument  is  too  frequently  abused,  by  intro- 


118 


CONTINUED  FEVER. 


ducing  it  as  an  auxiliary  in  cases  where  it  is  absolutely 
not  required.  If  there  be  congestion  or  great  arterial 
action,  one  decisive  bleeding  will  do  more  good  than 
double  the  same  quantity  of  blood  drawn  at  one  or  two 
bleedings  in  the  beginning.  The  pulse  must  be  the 
principal  guide  as  to  the  repetition  of  bleeding,  and  in 
all  cases  it  should  be  resorted  to  with  great  caution. 

Blisters,  are  frequently  applied  with  great  advantage 
to  the  nape  of  the  neck,  or  behind  the  ears;  mustard 
applications  are  frequently  very  useful  applied  over  the 
region  of  the  stomach  to  arrest  vomiting,  and  they  are 
employed  frequently  to  the  feet,  with  the  view  of  ex- 
citing irritation. 

Mercury. — In  many  fevers  calomel  has  been  consider- 
ed of  the  greatest  use,  especially  if  there  be  a  high  de- 
gree of  inflammation,  with  great  foulness  of  the  tongue ; 
and  it  is  nevertheless  true,  that  there  are  many  cases  of 
fever  that  can  be  treated  successfully  without  the  aid  of 
mercury ;  in  the  mass  of  cases,  probably,  where  mercury 
is  given,  its  success  is  greater  than  when  it  is  omitted ; 
but  I  am  satisfied  from  experience,  that  in  a  majority  of 
cases  calomel  is  frequently  too  active  for  the  intestines. 
I  substitute  generally  the  blue  pill,  in  connection  with 
hydrargyrum  cum  creta,  (calomel  and  chalk,)  which 
answers  in  many  cases  decidedly  better.  Mercury,  we 
are  aware,  if  pushed  too  far  in  this  fever  produces  great 
mischief;  and  we  have  been  frequently  compelled  to 
exhibit  with  our  remedies,  to  subdue  the  irritation  in 
the  alimentary  canal,  the  chalk  mixture,  with  the  infu- 
sion of  catechu  or  kino. 

Local  Complications. — It  is  necessary  in  every  case  to 
be  on  your  guard,  and  to  watch  minutely  for  local  in- 
flammation.   If  you  find  local  complications,  they  must 


CONTINUED  FEYER. 


119 


be  subdued  by  the  use  of  cups,  blisters,  &c. ;  as  regards 
drinks  in  this  fever,  I  am  in  favor  of  cold  water,  and  as 
much  as  the  patient  desires,  and  I  regard  it  as  one  of 
the  best  things  that  can  be  given. 

Whilst  upon  this  subject  of  continued  fever  we,  in 
common  with  most  writers,  include  the  description  of 
what  are  by  a  very  respectable  number  of  American 
physicians,  considered  as  two  distinct  affections,  and  fre- 
quently designated  at  the  present  time  under  the  names 
of  Typhoid  and  Typhus  fevers. 

The  former,  Typhoid  fever,  the  descriptions  of  which  by 
the  French  and  English  physicians  generally,  accord 
with  the  peculiar  phenomena  attending  continued  fever 
in  this  country.  Some  contend  that  the  difference  here 
alluded  too  are  of  a  secondary  importance,  whilst  others 
maintain  that  they  are  to  be  accounted  for  only  by  ad- 
mitting the  existence  of  two  radically  distinct  fevers,  as 
above  mentioned.  It  is  true  that  the  symptoms  we 
have  described  in  continued  fever  are  almost  precisely 
those  we  find  in  typhoid  fever,  many  contend  for  two  dis- 
tinct diseases;  and  in  Bartlett's  Treatise  the  subject  is 
handled  with  great  care,  and  in  that  masterly  manner 
in  which  that  distinguished  author  alone  seems  to  pos- 
sess the  faculty. 

Before  closing  my  article  on  this  subject,  I  cannot 
refrain  from  noticing  an  article  from  the  pen  of  Dr. 
Fenner,  of  New  Orleans,  in  reply  to  an  article  of  Dr. 
Boling  in  the  New  Orleans  Medical  Journal,  November 
ber  number,  1852.  Dr.  Fenner  there  takes  high  ground, 
in  what  he  terms  the  abortive  treatment  in  continued 
fever.  So  far  as  our  experience  goes,  we  are  inclined  to 
the  opinion  of  Dr.  Boling.  We  have  in  a  few  cases  only, 
administered  quinine  in  five  grain  doses,  and  the  result  in 


120 


CONTINUED  FEVER. 


our  cases  were  decidedly  injurious;  but  while  we  make 
this  assertion,  we  should  also  state,  in  justice  to  Dr. 
Fenner,  in  whose  professional  judgment  we  have  great 
confidence,  that  we  have  never,  in  any  case,  pressed  the 
quinine  treatment  to  the  extent  suggested  by  that  gentle- 
man. I  have  no  hesitation  hi  giving  credit  to  large 
doses  of  quinine  in  intermittent  and  remittent  fever,  and 
my  own  impression  is,  when  given  in  ten  grain  doses, 
they  exert  a  sedative  influence.  We  would  not  be  un- 
derstood as  condemning  the  suggestions  of  Dr.  Fenner, 
as  I  am  a  strong  advocate  of  quinine;  but  hi  the  mode 
in  which  I  have  administered  it,  in  this  form  of  fever, 
it  did  not  fulfil  my  expectations.  A  very  distinguished 
physician  in  Kentucky  condemns  the  use  of  quinine  in 
strong  terms  in  this  form  of  fever;  in  fact  he  adminis- 
ters nothing  but  barley  water  and  beef  tea,  keeps  the 
bowels  in  a  soluble  condition  by  enemas,  (injections,) 
and  at  intervals  to  produce  a  determination  to  the  sur- 
face, (produce  sweating)  gives  sj)iritus  mindererus  (solu- 
tion of  the  acetate  of  ammonia) ;  and  I  confess  this  mode 
of  treatment  I  have  adopted  in  a  few  cases  with  success. 
In  contradistinction  to  this  mode  of  treatment,  and  in 
sustaining  the  views  as  set  forth  by  Dr.  Fenner,  Dr.  E. 
Dundas,  in  an  article  in  the  Medical  Times,  (October  4, 
1851,)  considers  the  remittent  and  intermittent  fevers  of 
the  tropics  to  be  identical  with  the  typhus  of  this  coun- 
try, and  with  this  conviction  has  been  induced  to  treat 
the  latter  by  large  doses  of  quinine,  which  he  says  he 
has  found  so  efficacious  in  the  former.  (See  "Abstract," 
vol.  v.,  p.  163.)  The  doses  he  gives  are  ten  or  twelve 
grains,  repeated  at  intervals  not  exceeding  two  hours. 
Three  or  four  of  these  doses  will,  he  says,  in  general  be 
sufficient  to  exert  the  specific  influence  of  the  medicine, 


CONTINUED  FEVER. 


which  is  displayed  by  dizziness  of  the  head  and  tinnitus 
aurium,  (ringing  in  the  ears,)  or  in  the  rapid  subsidence 
of  all  the  urgent  symptoms.  In  the  latter  event,  he 
observes,  three  grains  of  quinine,  or  some  vegetable  bit- 
ter infusion,  should  be  administered  three  times  a  day, 
and  the  patient  supported  with  beef  tea,  or  other  light 
nutriment,  and  wine  if  necessary.  Should  the  urgent 
symptoms  return,  the  large  and  repeated  doses  of  qui- 
nine must  be  again  resorted  to. 

We  cannot  refrain  here  from  introducing  the  expe- 
rience of  Dr.  Douglass,  who  has  had  forty  years  expe- 
rience in  the  treatment  of  this  fever.  He  says  his  own 
plan  of  treatment  is  expectant.  "  In  the  first  place,  I 
never  have  recourse  to  quinine.  I  have  had  recourse  to 
every  plan  I  could  devise,  for  the  purpose  of  "breaking 
up"  the  disease  before  it  should  be  fully  developed,  but 
invariably  with  disappointment  to  myself,  and,  I  be- 
lieve, with  increased  suffering  to  the  patient.  In  my 
practice,  quinine,  given  in  doses  large  or  small,  and  in 
every  form,  in  no  single  instance  arrested  the  disease, 
but  often  increased  the  irritability  of  the  stomach,  the 
pain  in  the  head,  and  every  symptom  connected  with 
the  fever.  I  have  long  since  abandoned  it  as  absolutely 
pernicious."  He  is  opposed  to  purgatives  and  blood- 
letting, and  concludes  by  saying,  "to  conduct  a  patient 
safely  through  an  attack,  the  physician  should  econo- 
mise the  recuperative  energies  and  strength  of  the  suf- 
ferer from  the  beginning.  I  would  infinitely  prefer 
giving  cold  water  and  thin  gruel,  and  applying  blisters 
over  the  parts  affected,  and  doing  nothing  else,  than  to 
resort  to  the  vigorous,  heroic  attempts  to  arrest  this 
disease,  as  we  would  intermittent  or  bilious  fever." 

We  would  here  refer  the  reader  to  our  article  on  the 


122 


CONTINUED  FEVER. 


virtues  of  the  jessamine  in  this  disease,  which  will  be 
found  under  the  head  of  congestive  fever. 

In  regard  to  the  alleged  difference  which  exists,  and 
from  the  great  variety  of  names  that  are  applied  to  this 
form  of  fever,  it  is  really  calculated  to  embarrass  the 
mind  in  making  the  distinctions.  We  find  in  many 
authors  the  terms  typhus  fever,  common  continued  fever, 
slow  nervous  fever;  even  hospital  fever,  jail  fever,  camp 
fever,  malignant  fever,  putrid  fever,  contagious  typhus, 
and  petechial  fever.  If  they  are  really  unlike  each 
other,  and  if  the  diagnosis  between  them  can  be  dis- 
tinctly established,  how  important  it  must  be  to  draw 
the  line  of  distinction,  if  any  thing  like  success  is  to  be 
expected  in  its  treatment.  I  need  not  point  out  how 
necessary  it  is  to  sound  science,  that  we  should  under- 
stand the  difference  in  arriving  at  a  proper  diagnosis. 

In  Dr.  Armstrong's  "Practical  Illustrations,"  and  in 
Dr.  Southmond's  "Treatise  on  Fever,"  they  are  both 
complex  and  gratuitous  in  their  generalization,  and  their 
diagnosis  extremely  loose;  but  the  inference  is  to  be 
drawn  from  both  of  their  articles  that  there  exists  dis- 
tinctly two  forms  of  fever.  Dr.  Bartlett,  in  his  very 
able  treatise  on  this  subject,  (and  which  work  I  take 
great  pleasure  in  recommending  to  the  profession,)  says : 
"  The  common  continued  fever  of  Dr.  Armstrong  is,  I 
think,  the  typhoid  fever  of  Paris,  and  of  New  England." 
Some  of  the  leading  and  prominent  distinctions  between 
the  two  diseases  we  have  collated  from  the  chief  medi- 
cal works  which  have  been  written  on  these  two 
diseases,  by  those  who  were  satisfied  as  to  their  distinct- 
ness. 

1.  In  the  age  of  the  patient  they  affect.  Typhus 


CONTINUED  FEVER. 


123 


affects  all  ages,  young  and  old ;  typhoid,  chiefly  persons 
under  forty. 

2.  In  their  modes  of  attack,  typhus  being  sudden, 
typhoid  insiduous,  as  a  general  rule. 

3.  In  their  duration.  Typhus*  fever  is  of  much  shorter 
duration  than  typhoid. 

4.  Character  of  eruption.  Nothing  can  be  more  dis- 
tinct than  the  repeated  scanty  crops  of  rose-spots  in 
typhoid  fever,  with  their  bright  color,  their  disappear- 
ance under  pressure,  and  their  duration  of  three  or  four 
days,  compared  with  the  permanent,  dark  red,  or  mul- 
berry colored,  ineffaceable  rash  of  typhus. 

5.  In  the  color  of  the  skin,  the  expression  of  face,  and 
in  manner.  Typhus  patients  often  present,  in  the  high- 
est degree,  those  characters  which  the  old  writers  often 
termed  "  oppression  "  and  "  prostration."  The  face  is 
dark  and  generally  flushed,  the  complexion  muddy,  the 
manner  stupid  and  confused,  and  the  eyes  unintelligent. 
On  the  contrary,  in  typhoid  fever  the  complexion  does 
not  get  muddy,  consequently,  the  flush  of  the  cheeks, 
when  present,  is  bright  and  pinkish.  , 

6.  The  severity  and  peculiar  characteristic  symptoms 
of  the  head.  In  typhus,  headache  usually  ceases  on  the 
tenth  day,  and  always  before  the  fourteenth ;  in  typhoid 
fever  about  four  or  six  days  later.  Delirium  commences 
earlier  in  typhus  than  typhoid  by  several  days.  Somno- 
lence, although  frequently  absent  in  both,  is  more  com- 
mon and  earlier  in  typhus  than  in  typhoid. 

7.  In  the  degree  of  loss  of  muscular  power.  Typhus 
patients  almost  always  take  earlier  to  their  beds,  and 
are  more  completely  prostrated  at  an  earlier  date  than 
typhoid  cases. 

8.  Frequency  of  the  epistaxis,  (bleeding  from  the 


124 


CONTINUED  FEVER. 


nose.)    Rare  in  typhus,  rather  common  in  typhoid. 

9.  In  the  condition  of  eyes.  In  typhus  the  conjunc- 
tiva3  are  generally  injected  and  the  pupils  contracted ; 
in  typhoid  fever  the  conjunctivae  are  pale  and  the  pupils 
dilated. 

10.  The  condition  of  the  tongue;  which  is  drier, 
browner  and  larger  in  typhus,  is  more  frequently  small, 
fissured,  red,  or  partially  covered  with  a  pale  brown  fur 
in  typhoid. 

11.  Symptoms  of  the  chest.  Sonorous  bronchi,  or 
rale  sonore,  (a  sound  resembling  the  snoring  of  a  j^erson, 
at  others  the  sound  of  a  bass  string  of  an  instrument ; 
it  seems  to  be  caused  by  a  contraction  of  the  bronchial 
tubes,  and  is  characteristic  of  chronic  catarrh.)  This 
symptom  is  very  frequent  in  typhoid,  comparatively  rare 
in  typhus.  Pulmonary  congestion  common  in  typhus, 
rare  in  typhoid. 

12.  The  pulse ;  it  varies  more  in  typhoid  than  in 
typhus. 

13.  The  abdominal  symptoms.  The  abdomen  is  pain- 
ful on  pressure  in  about  three-fourths  of  typhoid  patients; 
is  almost  always  quite  painless  in  typhus.  The  abdo- 
men is  distended  and  resonant  more  or  less  in  all  cases 
of  typhoid ;  it  is,  with  scarcely  an  exception,  natural  in 
shape  or  even  a  little  concave  in  typhus.  Diarrhoea 
exists,  as  a  rule,  in  typhoid,  as  an  exception  in  typhus. 
Intestinal  discharges  are  different  in  the  two  diseases. 
In  typhoid  they  are  loose,  light  in  color,  and  alkaline ; 
in  typhus  they  appear  but  little,  if  at  all  altered  from 
health. 

14.  In  the  occurrence  of  ej^^icenomena,  (which  is  an 
adventitious  symptom  that  sometimes  occurs,  but  which 
is  not  connected  with  the  disease.)    Sloughing  from 


CONTINUED  FEVER. 


125 


pressure  is  equally  common  in  both  diseases,  but  erysi- 
pelas, phlibitis  and  local  inflammations  and  ulcerations 
are  much  more  common  in  typhoid  fever. 

15.  In  the  continuance  of  the  eruption  after  death. 
The  spots  of  typhus  last  unefFaceably  after  death ;  the 
rose  spots  of  typhoid  fever  cannot  be  found. 

In  addition  to  our  suggestions  on  continued  or  typhus 
fever,  we  append  some  recipes  that  have  received  the 
sanction,  generally,  of  the  profession  : 
3$5.    Carbonate  of  ammonia. 

Powdered  white  sugar. 

 gum  arabic  aa,  £iss. 

Compound  spirits  of  lavender,  Jii. 

Mint  water,  giv. 
Mix.    A  table-sjDoonful  every  two  or  three  hours.  A 
good  addition  sometimes  by  adding  laudanum  3i. 

This  is  a  good  prescription  when  the  system  is  in  a 
low  state.  As  a  stimulant  in  the  sinking  stages  of  this 
fever  the  following  prescription  will  answer  well : 

^.  Brandy. 

Cinnamon  water  aa,  5iv. 
Yolk  of  two  eggs. 
Sugar,  *ss. 
Oil  cinnamon,  gtts.  ii.  (drops.) 

Mix.  Give  it  in  small  portions  as  circumstances  dictate. 
In  petechial  typhus  take 

Comp.  infus.  of  Virginia  snake  root,  3xii. 
Tincture  allspice,  giv. 
Vinegar, 

Mix.  Give  three  or  four  tea-spoonfuls  every  four  or  six 
hours. 

When  your  patient  requires  a  stimulant,  and  the 


126 


CONTINUED  FEVER. 


brandy  preparation  does  not  meet  your  expectation,  you 
can  substitute  the  following  : 

1^.    Virginia  snake  root,  3vi. 
Proof  spirit,  Sv. 
Water  sufficient  to  obtain  six  fluid  ounces  of 
strained  fluid ;  after  one  hour  of  infusion,  add 
Camphor,  3ss. 
Balsam  Peru,  3i- 
Gum  arabic, 
Make  an  emulsion,  and  add 

Acetic  ether,  5i. 
Give  a  spoonful  every  hour  in  cases  requiring  stimu- 
lation, as  we  have  suggested. 

As  a  stimulating  injection  we  can  advise  the  following : 
3^.    Common  clyster,     ii.  pints. 
Camphor,  3ii. 
Yolk  of  egg,  i. 
Mix.  Use  one-fourth  at  a  time,  and  as  occasion  requires. 
The  habtisia  tinctoria  (or  wild  indigo)  has  been  highly 
extolled,  but  having  had  no  experience,  we  cannot  speak 
of  its  claims. 

Dr.  Willbur,  in  the  Southern  Medical  Journal,  recom- 
mends in  strong  terms  the  veratrum  viride  in  this  form 
of  fever.  We  have  never  tried  it,  consequently  cannot 
speak  of  its  merits.    It  is  very  highly  extolled. 

The  arnica  montana,  or  leopard's  bane,  is  highly  es- 
teemed in  Germany  as  a  stimulant  in  typhoid  fever ; 
they  generally  give  it  in  an  infusion,  by  taking  a  half 
ounce  of  the  flowers  to  a  pint  of  water,  and  given  in 
doses  from  a  half  ounce  to  an  ounce  every  three  or  four 
hours. 

Dr.  King  highly  extols  the  wild  indigo,  he  says : — 
"I  make  much  use  of  the  dried  alcoholic  extract  of  the 


CONTINUED  FEVER. 


127 


root-bark  in  the  low  stage  of  typhoid,  and  typhoid  con- 
ditions generally  in  conjunction  with  leptandrin;  and 
have  used  it  extensively  for  the  last  ten  years,  and  with 
very  excellent  effect  in  all  cases  of  a  tuberculous  cha- 
racter. I  take  pleasure  in  introducing  to  the  profession, 
the  active  principle  of  this  plant,  Baptisin,  prepared 
similarly  to  Aletrin,  or  it  may  be  precipitated  by  .acetate 
of  lead  from  the  saturated  tincture;  I  have  found  it  to 
exert  a  powerful  influence  on  the  glandular  system  in 
doses  of  from  one-fourth  to  one-half  a  grain ;  if  given  in 
large  doses  it  produces  a  very  disagreeable  prostration 
of  the  whole  system.  I  am  at  present  investigating 
this  article  with  a  view  to  obtaining  its  neutral  or  alka- 
loid principle,  and  which  will  undoubtedly  prove  a  va- 
luable addition  to  our  Materia  Medica."  . 

Dose  of  the  decoction,  made  by  boiling  one  ounce  of 
the  powdered  bark  in  two  pints  of  water,  down  to  one 
pint,  one  table  spoonful  every  one,  two,  or  four  hours, 
as  required ;  if  it  purge,  produce  nausea,  or  a  disagree- 
able relaxation  of  the  nervous  system,  lessen  the  dose, 
or  omit  its  use  for  a  time. 

I  have  used  in  this  form  of  fever  yeast  beneficially, 
by  mouth  and  injection. 

.  In  low  typhoid  fever  xanthoxylin  (prickly  ash)  will 
be  found  a  valuable  and  stimulating  tonic,  and  may, 
when  necessary,  be  added  to  laxatives  in  that  disease, 
to  prevent  too  much  prostration;  it  must,  however,  be 
employed  only  during  the  stage  of  prostration.  Dose, 
from  one  to  three  grains  three  or  four  times  a  day. 
(See  yellow  fever,  the  two  last  paragraphs.) 


128 


CONGESTIVE  FEVER. 


CONGESTIVE  FEVER. 

The  great  frequency  of  this  fever,  and  the  unusual 
fatality  attending  it  in  the  South,  renders  it  very  im- 
portant, and  worthy  of  the  most  serious  consideration 
from  the  profession;  and  we  do  assert  that  every  prac- 
titioner who  has  enjoyed  any  opportunities  for  observa- 
tion should  freely  give  the  most  ample  results  of  his 
experience.  Having  had  many  opportunities  when  a 
student  of  viewing  this  disease  in  Mississippi,  and  having 
witnessed  it  in  a  professional  capacity  in  this  portion  of 
the  state  of  Texas,  in  some  few  cases  in  its  most  malig- 
nant form,  we  have  concluded  to  give  an  article  upon 
its  symptoms  and  treatment,  and  in  doing  so,  we  will 
make  considerable  extracts  from  Eberle,  and  a  paper  on 
congestive  fever  by  Dr.  Barbour,  of  Tennessee.  We 
have  concluded  also  to  report  a  few  cases. 

Etiology. — In  regard  to  the  causes  of  this  form  of 
fever,  certainly  but  very  little  is  known.  Its  almost 
universal  occurrence  in  localities  which  are  favorable  to 
the  production  of  malaria;  its  co-existence  with  all  the 
common  varieties  of  miasmatic  fevers,  and  all  its  distin- 
guishing phenomena,  clearly  demonstrate  the  identity 
of  cause,  and  that  that  cause  must  be  some  powerful 
and  concentrated  poison,  generated  by  the  decomposi- 
tion of  organic  matter. 

It  requires  but  a  superficial  observation  of  the  phe- 
nomena of  this  disease,  to  be  convinced  that  this  cause, 
whatever  it  may  be,  makes  its  primary  impression  upon 
the  nervous  system;  and  that  all  of  its  characteristic 
symptoms  are  the  immediate  sequences  of  diminished 
nervous  sensibility.  The  suddenness  of  the  attack,  the 
numerous  indications  of  nervous  derangement,  and  the 


CONGESTIVE  FEVER. 


129 


rapidly  fatal  tendency  of  the  disease,  conclusively  show 
that  the  brain,  and  the  whole  nervous  system,  are 
almost  overwhelmed  with  the  first  paroxysm. 

The  impression  made  upon  the  nervous  system  is 
proportionate  to  the  intensity  of  the  malaria ;  and  the 
effects  upon  the  constitution  are  various,  according  to 
the  relative  force  of  vital  resistance ;  hence,  whenever  it 
prevails,  there  is  every  gradation  of  the  disease  from 
slight  manifestations  of  congestion,  to  the  most  malig- 
nant cases,  in  which  the  vital  forces  seem  to  be  com- 
pletely overpowered.  This  leads  me  to  the  considera- 
tion of  the  general  pathology  of  this  fever. 

The  whole  nervous  system  seems  to  be  oppressed  by 
a  powerful  morbific  poison;  and  the  phenomena  de- 
pendent upon  internal  engorgement  are  various,  accord- 
ing to  the  seat  and  extent  of  the  congestion.  When 
the  brain  is  the  chief  seat  of  congestion,  the  counte- 
nance appears  contracted;  there  is  pain  or  giddiness,  or 
a  sense  of  heaviness  in  the  head;  and  there  is  a  strong 
tendency  to  coma  and  insensibility.  When  the  lungs 
and  heart  are  principally  congested,  there  is  great  pre- 
cordial oppression ;  the  respiration  is  short,  hurried,  and 
oppressed,  and  there  is  generally  a  peculiar  livid  appear- 
ance in  the  face;  the  pulse  is  irregular  and  oppressed, 
and  there  is  general  coldness  of  the  surface.  Wlien  the 
abdominal  viscera  are  the  chief  seats  of  congestion, 
there  is  a  sense  of  great  heat  and  oppression  in  the 
region  of  the  stomach,  attended  with  great  thirst,  and  a 
constant  disposition  to  retching  and  vomiting;  there  is 
also  great  restlessness ;  sometimes  the  bowels  are  torpid, 
but  most  generally  they  are  very  loose,  thin  serous  dis- 
charges passing  off  in  enormous  quantities,  which  con- 
tribute rapidly  to  prostration  and  death.  It  is  said  that 
9 


130 


CONGESTIVE  FEVER. 


autopsic  examination  usually  reveals  the  true  source  of 
all  the  foregoing  symptoms.  The  various  organs  are 
found  more  or  less  gorged  with  blood,  which  was  the 
cause  of  their  oppression  and  embarrassment  during 
life. 

Symptoms. — The  premonitory  symptoms,  which  are 
generally  of  short  duration,  are  those  which  commonly 
precede  other  forms  of  fever,  such  as  languor  and  lassi- 
tude, a  sense  of  weariness  and  general  uneasiness,  loss 
of  appetite,  and  disturbance  of  the  stomach  and  bowels. 
Next  to  these  succeed  chilly  sensations,  alternated  by 
flashes  of  heat,  soon  after  which  the  patient  has  a  regu- 
lar paroxysm,  characterized  by  a  protracted  cold  stage ; 
the  system,  most  generally,  being  unable  to  recover  its 
natural  temperature  before  the  occurrence  of  the  second 
paroxysm.  Dr.  Eberle  says,  congestive  intermittents 
occur  seldom.  This  to  a  great  extent  is  true,  but  we 
frequently  in  this  climate  see  such  cases.  He  says  they 
are  marked  by  a  very  protracted  cold  stage,  deep-seated 
pain  in  the  head,  vertigo,  fainting,  a  sense  of  weight  or 
oppression  in  the  breast,  coma,  a  small  and  weak  pulse ; 
the  hot  stage  coming  on  very  slowly,  and  developing 
itself  very  imperfectly,  so  that  instead  of  hot  skin,  ft  Ashed 
countenance,  and  a  full  and  vigorous  pulse,  the  system 
continues  to  be  oppressed,  the  skin  scarcely  warm,  the 
countenance  pale  and  contracted,  the  breathing  confined 
and  anxious,  and  the  pulse  frequent,  small,  and  tense, 
with  an  internal  sensation  of  heat. 

The  type  of  this  fever  generally  corresponds  with  the 
double  tertian  of  old  authors,  being  subject  to  quotidian 
paroxysms,  but  on  each  alternate  day  to  an  increased 
aggravation  of  the  symptoms.  Thus  on  the  third  and 
the  fifth  days,  the  paroxysms  are  usually  very  severe, 


CONGESTIVE  FEVER. 


131 


and  followed  by  a  protracted  cold  stage,  from  which  the 
system  reacts  very  feebly.  The  anxiously  looked  for 
hot  stage  is  rarely  or  never  fully  developed,  even  in 
•  what  might  be  called  mild  cases.  But  instead  of  it,  the 
temperature  of  the  whole  surface  is  greatly  diminished 
and  irregular — the  extremities  being  much  colder  than 
the  trunk.  The  pulse  becomes  exceedingly  weak  and 
quick,  the  respiration  is  short,  hurried,  and  difficult 
with  generally  a  confirmed  hippocratic  countenance; 
the  patient  complains  of  a  painful  sense  of  heat,  and 
weight  in  the  epigastrium,  (region  of  the  stomach)  accom- 
panied with  insatiable  thirst;  there  is  uncontrollable  rest- 
lessness ;  the  patient  tosses  himself  from  side  to  side,  and 
often  rises  up  as  if  to  relieve  the  oppression  of  the  lungs ; 
there  is  either  pain-  or  giddiness,  or  sense  of  weight  in 
the  head;  and  the  countenance  looks  contracted,  pale, 
and  anxious,  and  often  livid ;  the  tongue  is  generally 
moist,  and  the  bowels  in  a  large  majority  of  cases  are 
loose,  and  the  dejections  serous.  These  are  the  general 
symptoms  at  an  early  period  of  the  disease ;  they  are  sub- 
ject, however,  to  considerable  modification  according  as 
the  brain  and  spinal  marrow,  the  lungs,  or  the  abdominal 
viscera  are  the  chief  seats  of  the  congestion;  the  most 
prominent  symptoms  in  all  cases  being  particularly  re- 
ferable to  the  chiefly  engorged  organs. 

If  the  condition  above  detailed  is  not  soon  removed 
by  the  recuperative  efforts  which  nature  makes  to  throw 
off  the  oppressive  load  under  which  she  is  laboring, 
aided  by  proper  remedial  agents,  there  is  a  rapid  ten- 
dency tx>  total  collapse.  This  usually  occurs  either  on 
the  third  or  the  fifth  day,  when,  as  has  been  remarked, 
the  paroxysms  are  unusually  severe.  This  condition  is 
marked  by  all  the  symptoms  which  indicate  profound 


132 


CONGESTIVE  FEYER. 


congestion.  The  extremities  and,  indeed,  the  whole 
surface  become  as  cold  as  ice ;  the  whole  body  is  bathed 
with  cold,  clammy  sweat ;  the  skin  loses  its  elasticity, 
resuming  very  slowly  its  natural  situation  when  pinched 
up ;  the  pulse  is  very  quick,  and  scarcely  perceptible ; 
the  thirst  is  great ;  incontrollable  and  extreme  restless- 
ness ;  the  respiration  becomes  shorter,  more  hurried  and 
oppressed,  and  there  are  strong  marks  of  diminished 
sensibility,  as  a  disposition  to  lethargy  and  even  to  coma, 
with  great  muscular  prostration.  If  unchecked,  these 
symptoms  increase  with  a  rapid  pace  and  soon  terminate 
in  death. 

But  congestive  fever  does  not  always  follow  the  regu- 
lar course  above  described.  Sometimes,  instead  of  suffo- 
cated excitement,  after  the  first  or  second  regular 
paroxysms  there  is  full  and  violent  reaction,  and  the 
stage  of  excitement  continues  twenty-four,  thirty-six  or 
forty-eight  hours  with  little  or  no  remission,  when  the 
system,  seeming  to  be  exhausted  by  the  violence  of  the 
excitement,  rapidly  sinks  into  collapse. 

This  modification  generally  occurs  when  there  are  in- 
ternal inflammations,  as  indicated  by  pressure  over  the 
epigastrium,  (the  region  over  the  stomach)  the  right 
hypochondriac  region,  (over  the  liver)  or  over  some  por- 
tion of  the  bowels. 

In  other  instances,  the  first  regular  paroxysm  is  suc- 
ceeded by  the  strongest  mark  of  deep  congestion  and 
complete  collapse  of  the  powers  of  nature.  So  far  as  my 
observations  have  extended,  this  last  modification  almost 
universally  occurs,  either  in  aged  persons  of  feeble  or 
broken  down  constitutions,  or  in  those  who  have  debili- 
tated themselves  by  the  use  of  harsh  purgatives  or  by  the 
use  of  a  too  common  remedy  among  Southern  planters, 


CONGESTIVE  FEVER. 


133 


the  emeto-cathartic,  salts  and  tartar,  and  it  is  frequently 
produced  by  the  use  of  patent  purgative  pills,  which  in 
almost  every  case  contain  some  powerful  drastic  prin- 
ciple which  generally  causes  great  irritation  of  the 
stomach  and  intestinal  irritation,  which  induces  a 
rapid  fluxionary  movement  in  the  circulating  fluid 
towards  the  chylopoietic  viscera,  (any  thing  connected 
with  the  formation  of  chyle,)  which  causes  inequality  of 
the  circulation,  and  rapidly  prostrates,  by  the  copious 
serous  discharges  which  ensue. 

"  Treatment. — This  is  certainly  the  most  important 
part  of  the  subject — in  ascertaining  the  treatment  neces- 
sary for  the  different  modifications  of  Congestive  fever. 
The  leading  indications  in  the  treatment  of  this  disease 
are  :  1st,  to  restore  tbe  lost  balance  of  the  circulation ; 
2d,  to  relieve  the  engorged  organs ;  and  3d,  to  restore 
the  suspended  secretions. 

The  great  discrepancy  of  opinions  which  have  been 
entertained,  and  the  great  diversity  of  agents  which 
have  been  applied  to  fulfil  the  plain  indications  of  treats 
ment,  clearly  show  that,  however  well  the  pathology 
may  have  been  understood,  great  uncertainty  has  existed 
in  regard  to  the  treatment.  Under  circumstances  very 
favorable  to  its  adoption,  general  and  topical  blood-let- 
ting might  be  resorted  to.  We  most  generally  find  our 
patient  with  a  feeble,  quick  pulse,  cold  skin,  and  other 
marks  of  great  prostration ;  and  in  such  a  case  we  should 
probably  resort  to  the  lancet,  but  in  doing  so  would  have 
great  doubt ;  this  would  be  correct,  as  we  should  always 
be  very  prudent  in  the  abstraction  of  blood,  especially 
in  this  climate.  Nevertheless,  in  the  commencement  of 
the  disease  we  are  very  certain,  from  our  knowledge  of 
its  pathology,  that  these  symptoms  do  not  arise  from 


134 


CONGESTIVE  FEYER. 


actual  debility,  but  only  from  engorgements  of  the 
internal  organs,  which,  most  generally,  are  not  at 
first  structurally  diseased,  but  only  oppressed  by  the 
undue  quantity  of  blood  forced  into  them.  Our  practice 
under  such  circumstances  is  cautiously  to  abstract  blood, 
and  in  almost  every  instance  it  has  had  a  tendency  to 
promote  reaction  by  diminishing  the  load  under  which 
the  heart  and  other  vital  organs  are  laboring.  Do  not 
understand  us  to  recommend  general  blood-letting  as 
admissible  at  all  times,  for  there  are  many  conditions 
and  many  circumstances  where  it  is  entirely  inadmis- 
sible ;  for  example,  it  would  be  highly  detrimental  in 
aged  persons  of  feeble  or  broken  down  constitutions ;  in 
persons  of  very  intemperate  habits ;  also  in  tlie  advanced 
period  of  any  case,  because,  in  all  of  these,  the  powers  of 
life  are  generally  at  a  low  ebb,  and  most  probably  the 
loss  of  blood  by  venesection  would  preclude  the  possi- 
bility of  reaction. 

Having  strictly  followed  the  practice  of  Dr.  Barbour 
in  some  three  or  four  instances,  I  can  do  no  better  than 
strictly  to  give  his  language  in  the  few  following  pages. 
I  would,  however,  remark,  that  I  have  succeeded  with 
the  calomel  treatment  in  large  doses,  and  podophyllin, 
as  well  as  the  stimulant  treatment,  some  few  cases  of 
which  I  shall  report. 

"  Blood-letting  is  particularly  indicated  in  those  cases 
where  high  excitement  continues  for  two  or  three  days 
after  the  paroxysm  with  little  or  no  abatement.  Under 
such  circumstances  it  is  certainly  one  of  the  best  means 
we  possess  to  lower  excitement."  In  high  arterial  excite- 
ment the  tinct.  aconite  will  generally  reduce  the  pulse 
and  cause  a  perfect  remission,  during  which  we  can 
make  use  of  such  remedies  as  are  calculated  to  prevent 


CONGESTIVE  FEVER. 


135 


the  recurrence  of  a  severe  paroxysm,  which  would,  most 
probably,  be  followed  by  collapse. 

"  When  general  blood-letting  is  considered  inadvisable, 
free  cupping  should  be  'substituted.  Cups  should  be 
applied  along  the  whole  course  of  the  spine,  over  the 
chest,  over  the  'epigastrium,  (the  stomach,)  over  the 
right  Irypochondriac  region,  (over  the  liver.)  or  over  the 
bowels,  according  as  the  indications  of  internal  conges- 
tion predominate  in  one  or  other  of  those  situations.  The 
revulsive  influence  exerted  by  this  operation  often  acts 
very  beneficially.  Having  bled  or  cupped  as  circum- 
stances indicated,  it  is  important  to  attend  to  the  condi- 
tion of  the  alimentary  canal.  The  stomach  is  generally 
very  irritable,  and  the  patient  complains  of  great  thirst 
and  heat  in  the  epigastrium,  to  relieve  which  a  large 
sinapism  (mustard  plaster)  should  be  applied  over  the 
stomach,  and  small  portions  of  cold  water  or  iced  lemon- 
ade or  small  quantities  of  ice  should  be  given.  These 
are  exceedingly  grateful ;  they  lessen  the  burning  heat 
and  thirst,  and  often  compose  the  stomach.  If  they  fail 
cups  should  be  applied  over  the  epigastrium,  and  if 
necessary,  a  large  blister  should  follow  them.  These 
combined  means  rarely  fail  to  tranquillize  the  stomach. 

The  bowels  are  sometimes  torpid  when  the  evacua- 
tions are  either  clay  colored  or  of  a  muddy  or  tarry 
color, — conditions  which  indicate  either  a  suspended  or 
a  greatly  vitiated  secretion.  Most  frequently,  however, 
the  bowels  are  very  loose  and  the  discharges  serous, 
with  a  great  quantity  of  small  black  particles  in  the 
bottom  of  the  vessel  containing  them,  resembling  coffee 
grounds."  This  appearance  is  attributed  by  most  Southern 
practitioners  to  the  oxydisement  of  the  mercury,  which 
is  so  plentifully  administered  in  the  form  of  calomel. 


136 


CONGESTIVE  FEVER. 


My  own  impression  is  that  it  is  the  result  of  morbid  secre- 
tion from  the  liver  and  bowels.  If  the  bowels  are  torpid 
and  the  dejections  are  unnatural,  the  best  combination 
I  know  of  is, 

Podophyllin,        ii.  grs.  or  Calomel  v  grs. 
Rhubarb,  v.  " 

Ipecacuanha,  .  i.  " 
made  into  two  or  three  pills,  and  given  every  four  or 
six  hours,  so  as  gently  to  evacuate  the  intestines  once 
or  twice  in  the  course  of  the  day ;  some  combine  aloes, 
but  I  look  upon  it  as  too  harsh,  having  a  tendency  to 
produce  great  irritation  in  the  alimentary  canal,  and  it 
excites  an  undue  irritation  in  the  mucous  coat  of  the 
bowels.  Some  Southern  practitioners  recommend  large 
doses  of  calomel,  from  one  hundred  to  three  hundred 
grains,  and  repeat  them  often,  and  make  positive  assu- 
rance, when  thus  administered,  that  they  have  done 
more  good  than  with  all  the  other  remedies  besides.  I, 
myself,  resorted  to  this  treatment  in  the,  case  of  a  distin- 
guished citizen  of  Grimes  county,  (my  experience  was 
limited,  and,  thank  God,  my  patient  recovered ;  but  we 
would  not  now  be  guilty  of  such  folly,  especially  when 
we  have  remedies  like  podophyllin,)  which  case,  for  its 
novelty  and  the  extraordinary  doses  administered,  I 
shall  report  on  another  page. 

If  the  discharges  are  very  thin,  it  is  important  to 
suppress  them  as  soon  as  possible.  For  this  purpose  I 
generally  use  the  following  combination : 

Podophylline  1  gr.,  or  Calomel,      v  grs. 
Camphor,  v  " 

Opium,  1  " 

and  give  every  four  or  six  hours,  according  to  the  copi- 
ousness, and  frequency  of  the  discharges.    The  above 


CONGESTIVE  FEVER. 


137 


means,  thus  combined,  are  admirably  calculated  to  re- 
strain the  bowels,  to  unlock  the  liver,  and  at  the  same 
time  to  determine  to  the  surface.  Having  attended  to 
the  alimentary  canal,  the  most  important  indication 
which  demands  our  attention  is  to  restore  the  lost  ba- 
lance of  the  circulation,  by  the  adoption  of  every  revul- 
sive means  in  our  power. 

In  the  most  cases  the  pulse  is  as  small  as  a  thread, 
sometimes  imperceptible;  and  the  whole  surface  is  as 
cold  as  ice,  attributable  to  a  complete  recession  of  the 
vital  fluid  from  the  extreme  vessels,  and  to  the  engorge- 
ment and  consequent  oppression  of  nature's  calorificator, 
the  lungs ;  and  unless  these  conditions  can  be  soon  over- 
come by  means  calculated  to  equalize  the  circulation, 
nothing  can  effect  any  good. 

There  is  such  a  variety  of  opinions  as  to  the  best 
means  of  accomplishing  this  object,  that  we  shall  not 
attempt  even  a  synopsis,  but  content  ourselves  with 
giving  our  views,  and  at  the  same  time  remark,  we 
have  unlimited  confidence  in  them,  but  that  they  do  not 
in  general  harmonize  with  the  opinions  of  many  others. 

In  all  the  worst  cases  of  this  disease  which  have  come 
under  my  notice,  the  hot  bath  and  most  diffusible  stimu- 
lants have  done  injury  rather  than  good,  the  patients 
appearing  generally  more  relaxed  and  oppressed  after 
they  had  been  used.  The  remedy  which  I  estimate  above 
all  others  in  the  treatment  of  congestive  fever  is  the 
effusion  of  cold  water.  My  own  comparatively  limited 
experience,  and  the  ample  experience  of  many  intelli- 
gent practitioners  in  this  country,  for  instance,  Drs. 
Dickson,  Rogers,  Minnock,  &c,  sustain  me  in  the  decla- 
ration that  the  effusion  of  cold  water  upon  the  naked 
body,  is  capable  of  producing  the  most  beneficial  effects ; 


138 


CONGESTIVE  FEVER. 


and  in  a  large  majority  of  even  the  most  malignant 
cases,  of  inducing  complete  and  permanent  reaction. 
So  well  am  I  assured  of  its  invaluable  efficacy  as  a 
powerful  excitant  to  the  nervous  system,  that  I  now 
feel  no  more  hesitation  in  its  adoption  than  I  do  in  the 
use  of  aconite  or  the  lancet,  if  necessary,  in  inflammatory 
affections,  for  the  principle  upon  which  it  operates  is 
just  as  obvious  to  my  mind. 

Who  would  hesitate  to  dash  cold  water  on  a  patient 
who  was  overwhelmed  by  the  effects  of  opium  ?  Surely 
no  practical  medical  man  would  if  he  knew  its  efficacy. 
Why  ?  Because  it  is  known  to  be  capable  of  arousing 
and  sustaining  the  oppressed  nervous  system  by  the 
stimulant  impression  which  it  makes  upon  it.  Why 
then  should  there  be  a  doubt  about  its  applicability  to 
a  disease  which  we  believe  to  be  dependent  upon  a 
poison  which  oppresses  and  paralyses  the  whole  nervous 
system?  The  analogy  as  regards  the  condition  in  the 
two  cases  is  perfectly  just,  and  the  principle  upon  which 
the  remedy  acts  is  identical.  That  this  is  the  fact,  its 
almost  universal  effects  abundantly  testify. 

The  modes  of  application  which  I  have  adopted  are 
the  following : — Have  a  broad  plank  placed  upon  two 
chairs,  at  a  convenient  distance  apart,  and  place  two 
vessels  of  hot  water  on  each  side,  corresponding  with 
the  feet  and  hands;  then  strip  the  patient  and  lay  him 
on  his  back  on  the  plank,  with  his  extremities  in  the 
hot  water,  and  having  at  hand  twenty  or  thirty  gallons 
of  cold  water,  or  what  would  be  better,  water  made 
colder  by  ice  or  salt,  pour  the  water  from  a  pitcher,  in 
a  full  and  rapid  stream  over  the  chest  and  abdomen. 
The  advantage  of  this  mode  is,  that  the  cold  is  directly 
applied  over  the  most  common  seat  of  congestion,  whilst 


CONGESTIVE  FEYER. 


139 


the  circulation  is  invited  to  the  extremities  by  the  hot 
water. 

The  second  mode  which  I  adopt,  particularly  in  cases 
where  the  brain  and  spinal  marrow  are  the  chief  seats 
of  congestion,  is  to  place  the  patient  upon  a  blanket  on 
the  floor,  and  cause  him  to  turn  upon  his  side,  and  dash 
cold  water  as  forcibly  as  possible  over  the  head  and 
down  the  spinal  column.  This  method  is  often  the  most 
effectual,  because  its  influence  is  more  immediately  felt 
by  the  great  nervous  centres.  Having  applied  the  water, 
the  patient  should  be  quickly  dressed  and  placed  in  bed, 
and  be  covered  with  two  or  three  blankets.  I  have 
sometimes  had  the  patient  surrounded  with  hot  stones, 
or  bottles  filled  with  hot  water,  after  being  placed  in 
bed;  but  I  am  now  satisfied  that  it  is  improper  to  do  so, 
on  account  of  the  relaxing  influence  of  the  heat,  and 
the  debilitating  effects  of  the  copious  perspiration  in- 
duced by  it.  Instead  of  heating  the  patient,  I  cause 
him,  as  soon  as  he  has  received  the  cold  dash,  and  is 
placed  in  bed,  to  be  extensively  and  forcibly  rubbed, 
either  with  dry  mustard  or  salt,  or  with  spirits  of  tur- 
pentine. 

Under  the  combined  influence  of  these  agencies,  re- 
action, if  at  all  possible,  soon  ensues ;  the  surface  rapidly 
recovers  its  natural  temperature;  the  pulse,  from  being 
quick  and  thready,  becomes  fuller,  softer,  and  more  re- 
gular; the  respiration  becomes  easy;  the  countenance 
becomes  fuller  and  more  animated;  and  from  insatiable 
thirst,  and  uncontrollable  restlessness,  the  patient  often 
experiences  so  much  relief  that  it  is  not  uncommon  for 
him  to  fall  into  a  quiet  and  refreshing  sleep,  from  which 
he  awakes  greatly  improved. 

The  effects  of  the  cold  dash  are  frequently  perma- 


140 


CONGESTIVE  FEVER. 


nent,  and  complete  reaction  takes  place,  followed  by 
rapid  convalescence.  In  many  instances,  however,  the 
effects  of  the  first  infusion  subside,  and  the  patient  re- 
lapses into  his  former  condition  of  coldness,  restlessness, 
and  insensibility.  In  such  cases  it  is  proper  to  repeat 
the  effusion,  until  complete  and  permanent  reaction 
takes  place,  which  may  be  confidently  anticipated  in  a 
large  majority  of  even  the  worst  cases,  provided  it  is 
applied  sufficiently  early. 

Unfortunately  for  the  reputation  of  this  invaluable 
remedy,  it  is  deferred  too  long,  and  most  generally  re- 
sorted to  as  a  dernier  resort;  in  consequence  of  which 
the  system  looses  all  susceptibility  of  its  impression;  or 
some  vital  organ,  or  organs,  become  irreparably  injured, 
and  hence  its  use  proves  abortive. 

There  is  no  just  reason  why  its  adoption  should  be 
delayed.  If  it  is  capable  of  producing  such  salutary 
effects  in  the  latter  periods  of  the  disease,  when  the 
vital  principle  is  almost  extinguished,  how  much  more 
triumphant  would  be  the  success  attending  the  use  at 
an  earlier  period,  when  the  vital  organs,  most  generally, 
are  not  seriously  injured,  but  only  burdened  with  an 
undue  quantity  of  blood,  and  when  the  susceptibility  of 
impression  is  but  little  impaired. 

As  auxiliaries  to  the  cold  effusion  I  generally  apply 
cups  along  the  course  of  the  spine,  over  the  epigastrium, 
over  the  right  hypochondriac  region,  or  over  the  bowels, 
according  to  the  indications,  and  at  the  same  time  have 
warm  mustard  plasters  applied  to  the  extremities,  and 
over  the  different  seats  of  congestion ;  or  have  the  whole 
surface  well  rubbed  with  strong  mustard  flour.  I  have 
sometimes  derived  considerable  benefit  from  the  applica- 


CONGESTIVE  FEVER. 


141 


tion  of  a  narrow  mustard  plaster  along  the  whole  course 
of  the  spine. 

When,  however,  there  are  strong  marks  of  cerebral 
congestion,  a  blister  to  the  back  of  the  head  and  over 
the  cervical  portion  of  the  spine  is  decidedly  preferable. 
Diffusible  stimulants  seem  to  be  indicated,  and  I  usually 
indulge  the  patient  with  occasional  portions  of  any  of 
them  which  appear  to  agree  best  with  the  stomach. 
Brandy,  and  in  fact  all  spirituous  liquors,  in  most  in- 
stances which  have  come  under  my  observation,  appear 
to  increase  the  oppression  and  sickness  of  the  stomach. 
Good  porter  is  far  preferable  to  all  other  stimulants  of 
this  class,  and  patients  are  generally  very  fond  of  it. 

If  we  succeed  by  the  above  means  in  producing  com- 
plete reaction,  what  course  of  treatment  should  be  after- 
wards pursued  ?  If  the  reaction  is  moderate,  which  is 
most  usually  the  case,  all  that  will  be  necessary  will  be 
to  administer  mild  aperient  and  alterant  medicines  in 
combination,  in  order  to  regulate  the  bowels  and  restore 
the  biliary  and  other  secretions  to  a  healthy  condition, 
and  at  the  same  time  remedies  calculated  to  sustain  the 
weakened  powers  of  nature,  and  to  prevent  the  recur- 
rence of  the  paroxysm,  to  which  there  is  always  a  great 
liability.  The  combination  I  use.  with  the  view  to  the 
fulfilment  of  the  first  indication,  is  from  three  to  five 
grains  of  blue  mass, 

Rhubarb,  v.  gr. 

Opium,  i.  gr. 

every  six  or  eight  hours,  until  the  secretions  become  of 
natural  color  and  consistence.  To  fulfil  the  second  in- 
dication, I  give  from  ten  to  twenty  grains,  and  even  as 
much  as  forty  grains  of  quinine,  and  five  to  ten  grains 
of  Dover's  powders  every  three  or  four  hours.    I  gene- 


142 


CONGESTIVE  FEVER. 


rally  confine  the  use  of  this  combination  to  the  forenoon, 
beginning  with  it  at  about  four  o'clock  in  the  morning 
and  repeat  it  at  eight  and  twelve ;  after  which  I  substi- 
tute infusion  of  serpentaria,  (Virginia  snake  root,)  be- 
cause there  is  commonly  some  tendency  to  excitement 
in  the  afternoon.  For  the  same  reason,  if  it  is  deemed 
necessary  to  administer  aperient  medicines,  they  should  be 
given  in  the  evening,  as  there  is  then  much  less  liability 
to  a  depression  of  the  system  from  depletion  in  any  form. 

Sometimes,  however,  the  reaction  is  violent,  and  un- 
less it  is  moderated,  the  organs  which  have  just  been 
gorged  with  blood,  and  consequently  weakened  and  irri- 
tated, will  rapidly  become  the  seats  of  violent  inflamma- 
tion, which  will  be  difficult  of  removal  on  account  of  the 
inability  of  the  system  to  bear  depletion  to  any  great 
extent.  In  such  cases,  it  is  necessary  to  apply  cups 
over  the  various  seats  of  congestion,  administer  calomel, 
and  after  it  infusion  of  senna  with  ginger,  and  repeatedly 
use  either  the  cold  or  the  tepid  effusion.  If  these  means 
fail  it  may  be  proper  to  draw  blood  from  the  arm ;  but 
this  should  be  done  with  the  greatest  caution,  as  the  power 
of  resistance  in  these  cases  is  generally  so  low  that  not 
unfrequently  high  excitement  is  suddenly  followed  by 
symptoms  of  prostration.  In  cases  where  blood-letting 
seems  to  be  demanded  the  pulse  should  be  very  carefully 
watched,  and  upon  the  slightest  manifestation  of  failure 
the  orifice  should  be  closed,  and,  if  necessary,  a  little 
wine,  brandy  or  porter  should  be  given. 

The  above  means  are  usually  sufficient  to  reduce  the 
excitement  to  a  proper  standard,  when  the  alterant  and 
aperient  combination,  together  with  quinine,  can  be  ad- 
ministered as  above  directed. 

Suppose,  however,  that  notwithstanding  the  diligent 


CONGESTIVE  FEVER. 


143 


use  of  all  the  means  which  have  been  recommended  for 
the  purpose  of  arousing  a  patient  from  the  collapse  of 
congestive  fever,  he  still  continues  without  any  reaction, 
what  should  be  done  ?  I  seriously  apprehend  that  no- 
thing can  be  effectual,  as  in  such  cases,  generally,  the 
injury  done  to  the  vital  organs  is  irreparable.  Still,  as 
we  should  never  abandon  a  patient  until  he  is  completely 
gone,  as  sometimes  patients  recover  contrary  to  all  reason- 
able expectations  of  physicians  and  friends,  it  is  our  duty 
to  continue  unremittingly  to  apply  every  means  which  can 
possibly  in  our  opinion  do  good.  Under  such  circum- 
stances, I  would  chiefly  rely  upon  the  occasional  use  of 
the  cold  bath,  large  and  numerous  sinapisms,  blisters,  hot 
spirits  of  turpentine,  calomel  often  repeated  in  small 
doses,  large  doses  of  quinine,  and  the  free  use  of  brandy 
or  porter. 

"  In  conclusion,  I  will  briefly  notice  the  most  appro- 
priate regimen  during  the  continuance  of  the  disease 
and  in  convalescence.  It  will  be  remembered,  that  in 
congestive  fever  the  stomach  and  bowels  are  in  an  en- 
gorged and  oppressed  condition,  and  that  in  consequence 
their  important  functions,  digestive  and  chylification, 
are  greatly  impaired;  hence,  it  is  very  necessary  to 
adapt  the  aliment  to  the  weakened  digestive  organs, 
otherwise  it  is  sure  to  become  a  source  of  increased  irri- 
tation. Rice  water,  barley  water,  arrow  root  tea,  well 
made  gruel  or  beef  tea  are  the  best  articles  of  diet 
during  the  course  of  the  disease,  and  also  for  several 
days  after  convalescence  commences.  After  the  strength 
of  the  digestive  organs  has  somewhat  improved,  chicken 
broth,  boiled  milk,  or  milk  and  mush  would  be  appro- 
priate. For  drink  good  porter  is  best,  or  a  good  article 
of  wine." 


144 


CONGESTIVE  FEVER. 


Casel. — Judge, S.,  aetat  forty-two.    I  was  called  to 
this  gentleman  in  the  spring  of  '44 ;  he  had  had  an 
attack  of  remitting  fever,  and  from  neglect  upon  his  part, 
the  disease  changed  its  type  into  that  of  congestive ;  he 
had  been  visited  by  an  able  physician  and  pronounced 
hopeless.  When  I  was  called  in  I  found  him  in  a  coma- 
tose condition;  he  apparently  was  insensible  to  sur- 
rounding objects;  he  had  not  spoken  for  fifty  or  sixty 
hours,  his  pulse  was  small  as  a  thread,  sometimes  im- 
perceptible; the  whole  surface  was  as  cold  as  ice,  and 
particularly  the  extremities,  with  an  extraordinary  de- 
gree of  constipation  of  the  bowels;  it  required  no  pro- 
phetic spirit  to  tell  that  he  would  die  if  not  relieved. 
His  lady,  a  female  of  fine  sense,  had  informed  me  that 
she  had  given  various  purgatives  and  injections,  without 
producing  any  action.  I  was  therefore  satisfied  it  would 
be  folly,  as  there  was  no  time  to  delay,  to  persist  in  re- 
medies which  had  already  failed.    I  conceived  him  in 
the  last  stage,  and  had  no  hope  of  even  the  cold  dash; 
was  requested  by  his  friends  to  let  him  alone,  as  they 
were  satisfied  nothing  could  be  done.    I  determined, 
from  the  authority  of  Dr.  Cook,  where  the  secretions 
were  so  completely  locked  up,  to  risk  every  thing  on 
calomel;  I  immediately  gave  him  200  grains  of  calomel, 
which  not  having  operated  in  six  hours,  was  repeated 
with  the  addition  of  an  hundred  grains;  this  dose  was 
repeated  afterwards,  and  during  the  time  I  literally  co- 
vered him  with  sinapisms,  and  had  him  constantly 
rubbed  with  hot  brandy  and  pepper;  his  lady  being  a 
strong  believer  in  stimulating  injections  I  did  not  forbid 
them,  but  withal  we  had  as  yet  produced  no  action 
on  the  bowels.    I  suggested  an  injection  of  cold  water, 
which  was  immediately  followed  by  a  very  copious  and 


CONGESTIVE  FEVER. 


145 


bilious  evacuation  of  a  very  thick  consistence,  after  this 
evacuation  there  was  a  slight  reaction,  and  I  immedi- 
ately gave  him 

Quinine,  20  grs. 

Camphor,  10  " 

every  two  hours,  until  he  had  taken  ten  doses;  the  sys- 
tem reacted  kindly  under  the  influence  of  this  last  pre- 
scription; the  remedies  administered  produced  copious 
bilious  evacuations — the  quinine  was  .cdhtinued  for  some 
days,  my  patient  soon  became  convalescent,  and,  strange 
to  say,  the  salivation  produced  from  the  calomel  was  very 
slight — since  this  attack  he  has  enjoyed  uninterrupted 
health.  It  cannot  be  questioned  that  the  only  fear  from 
this  practice,  is  the  fear  of  the  injurious  effects  on  the 
mouth.  But  we  would  not  be  understood  to  say  that 
we  even  approve  of  the  practice,  only  to  be  justified 
under  similar  circumstances.  But  is  the  bare  appre- 
hension of  the  most  dreadful  salivation  more  terrible 
than  certain  death  ?  Surely  not.  The  risk  of  saliva- 
tion in  these  extreme  cases,  is  less  than  is  supposed.  I 
have  never  known  a  patient  that  absolutely  required 
some  energetic  mode  of  procedure,  to  be  badly  salivated 
after  taking  the  largest  dose.  When  ptyalism  (saliva- 
tion) is  produced,  I  have  had  but  little  difficulty  in 
arresting  it,  with  Tinct.  Iodine,  and  a  weak  solution  of 
the  sulphate  of  copper  in  water.  This  is  the  case  we 
have  alluded  to  before — we  would  really  hesitate  now 
in  trying  it  again. 

Case  2. — Mrs.  T.,  aetat  thirty-four.  I  was  called  to 
this  lady  in  the  spring  of  '46 ;  she  had  been  attacked 
with  a  severe  intermittent  fever,  and  whilst  in  the  cold 
stage  of  this  fever  she  was  bled  by  her  husband ;  the 
consequence  was,  that  it  prostrated  her,  and  her  system 
10 


14G 


CONGESTIVE  FEYER. 


did  not  react,  and  the  chill,  from  a  simple  intermittent, 
was  changed  to  a  congestive  chill.  I  found  her  covered 
with  a  cold  clammy  perspiration,  pulse  very  feeble,  respi- 
ration hurried ;  great  uneasiness,  and  a  general  prostra- 
tion of  the  whole  system.  I  immediately  corded  the 
left  extremities,  I  gave  the  cold  dash  in  the  face,  had 
the  body  rubbed  dry,  and  immediately  commenced  the 
quinine,  having  ascertained  that  the  biliary  secretions 
were  in  a  good  condition,  (I  view  the  administration  of 
quinine  as  useless  almost,  unless  the  biliary  secretions 
are  aroused)  with  the  following  prescription, 


I  never  combine  the  opium  where  there  is  any  thing 
like  congestion  upon  the  brain.  This  prescription  was 
given  every  two  hours, — reaction  was  established  after 
the  third  dose,  when  quinine  was  given  in  combination 
with  pipeline,  ten  grains  of  the  former  and  one  of  the  lat- 
ter, every  four  hours ;  my  patient  had  a  return  of  the 
chilly  but  the  same  treatment  was  pursued,  and  she  was 
soon  convalescent. 

Case  3. — Mrs.  M.,  aetat  fifty.  This  lady's  attack  was 
of  a  congestive  character;  I  saw  her  about  the  third 
day,  and  her  situation  was  extremely  critical.  She  was 
in  a  cold  clammy  perspiration,  no  pulse  had  been  per- 
ceived at  the  wrist  for  twelve  hours ;  very  restless,  with 
very  cold  extremities.  I  immediately  had  the  body 
brushed  hard  with  a  flesh  brush,  rubbed  the  spine  with 
warm  mustard,  and  blistered  the  extremities  largely; 
she  was  sinking  very  fast,  ammonia  was  administered. 
On  examining  the  blisters,  four  hours  after  they  had 


Podophyllin, 
Quinine, 
Camphor, 
Opium, 


ss.  grs, 
10  " 
10  " 
1  " 


CONGESTIVE  FEVER. 


147 


been  put  on,  I  discovered  the  cuticle  was  not  the  least 
irritated;  under  these  circumstances,  I  resolved  on  a 
desperate  course,  I  immediately  applied  the  actual 
cautery  to  the  extremities,  continuing  all  the  time  rub- 
bing the  body ;  after  cauterizing,  I  dressed  the  wounds 
with  a  sinapism,  and  in  less  than  an  hour  I  had  the 
satisfaction  of  feeling  the  pulse  at  the  wrist.  I  con- 
tinued the  ammonia,  and  gave  three  grains  of  quinine 
every  fifteen  minutes,  until  ninety  grains  had  been 
taken;  this  produced  complete  re-action,  after  which 
five  grains  of  blue  mass  was  ordered ;  in  the  course  of 
the  day  it  operated  well.  Quinine  and  camphor  was 
continued  in  five  grain  doses  every  two  hours,  my 
patient  had  no  return  of  chill,  and  in  a  few  days  she 
became  convalescent. 

Case  4. — Mr.  K.,  aetat  sixty.  I  was  called  to  this 
worthy  old  gentleman  in  the  month  of  August,  '47 ;  I 
found  him  in  a  most  deplorable  condition,  his  situation 
was  that  of  collapse;  after  examining  the  patient  tho- 
roughly, I  was  satisfied  he  could  not  recover,  and  so 
informed  his  friends;  he  had  extensive  gastritis,  and 
in  fact  there  was  inflammation  of  the  whole  alimentary 
canal.  I  report  this  case,  with  the  hope  that  it  may  do 
good  in  deterring  others  from  pursuing  a  course  which 
is  becoming  too  common  in  the  South — as  I  am  satisfied 
this  old  man  lost  his  life  from  a  too  free  use  of  a  patent 
medicine.  Upon  inquiry,  I  was  informed  that  he  had 
had  the  fever  for  some  two  or  three  days,  and  that  he 
had  been  taking  a  quantity  of  Spenser }s pills — these  pills 
were  old,  and  not  operating  according  to  directions,  he 
repeated  and  repeated  again,  the  result  was,  that  when 
the  fever  left  him,  it  left  him  prostrated ;  about  this 
time  the  medicine  commenced  operating,  and  producing 


148 


CONGESTIVE  FEVER. 


the  most  extensive  serous  discharges.  I  was  called 
whilst  he  was  purging,  but  the  work  was  done,  he  was 
icy  cold ;  I  arrested  the  discharges  as  soon  as  possible, 
but  it  was  too  late, — all  patent  pills  generally  have 
combined  a  drastic  cathartic ;  they  are  almost  certain 
to  produce  serous  discharges,  and  when  taken  in  an 
over  quantity,  are  as  certain  to  produce  inflammation. 
This  was  the  result  here,  and  it  was  the  second  case  I 
had  been  an  eye  witness .  to,  of  the  fatal  effects  of 
these  nostrums;  they  are  the  cause  of  many  deaths, 
and  we  frequently  see  them  heralded  forth  with  the 
signatures  of  individuals,  as  testimonials,  which  we  view 
as  very  wrong, — and  we  have  seen  an  article  so  com- 
pletely covering  the  case,  that  we  have  determined  to 
insert  it. 

9  We  can  scarcely  open  a  newspaper,  without  meeting 
with  the  advertisement  of  one  or  more  quack  medicines, 
recommended  and  avouched  by  clergymen.  Now,  such 
is  the  confidence  of  the  mass  of  the  people  in  their  spi- 
ritual pastors,  that  these  certificates  have  in  them  a 
power  even  greater  than  the  forged  testimonials  of  emi- 
nent deceased  physicians,  so  often  seen  appended  to  the 
same  advertisements.  Such  being  the  case,  we  would 
respectfully  ask  our  clerical  friends,  to  whom  we  attri- 
bute no  bad  motive  in  this  matter,  whether  they  have 
ever  reflected  on  the  mischief  they  do  to  the  community 
by  these  recommendations  ?  Do  they  not  know,  that  if 
a  nostrum  be  inert,  a  reliance  upon  it  may  destroy  life; 
if  active,  that  while  it  may  relieve  or  even  cure  a  few,  it 
will  kill  many  more?  We  would  charitably  believe 
that  most  of  these  certificates  are  given  without  due 
reflection.  The  majority  of  them  are  for  fevers,  cough f 
mixtures,  balsams,  boluses  or  lozenges,  which  are  pre- 


CONGESTIVE  FEVER. 


149 


sented  as  infallible  remedies,  without  reference  to  the 
nature  of  the  disease  in  the  lungs,  by  which  the  cough 
is  produced.  But  the  diseases  of  the  lungs  are  of  vari- 
ous kinds — requiring  different  modes  of  treatment — and 
what  may  cure  one  patient  will  destroy  another.  If  a 
clergyman,  then,  has  seen  a  quack  medicine  relieve  one 
individual,  he  certainly  is  not  justified  in  generalizing 
and  commending  it  to  all  who  may,  from  the  coinci- 
dence of  a  single  symptom,  fancy  themselves  in  the  same 
condition. 

Medicine  is  an  inductive  science,  the  basis  of  which 
is  a  knowledge  of  the  structure  and  functions  of  the 
human  body.  How  many  of  our  clergymen  under- 
stand anatomy  and  physiology,  beyond  Dr.  Paley's 
Natural  Theology  ?  We  suspect  very  few.  We  would 
ask  these  respected  brethren  what  they  mean  by  ortho- 
doxy ?  Is  it  not  a  full  acquaintance  with  the  letter  and 
spirit  of  the  Bible,  and  a  faithful  adherence  to  both  ? 
Now  medicine,  if  I  may  make  a  comparison,  has  its 
orthodoxy,  which  consists  in  a  profound  knowledge  of 
the  principles  of  the  science,  and  a  reliance  on  them  to 
guide  us  in  practice,  as  the  divine  relies  on  the  doctrines 
of  the  Bible  to  guide  and  govern  him  in  preaching.  If 
some  ignorant  layman,  but  superficially  acquainted  with 
that  divine  revelation,  and  unimbued  with  its  spirit, 
were  to  advertise  a  new  exposition  of  its  doctrines — a 
sort  of  patent  mode  of  securing  Heaven — what  would  our 
clerical  friends  say,  if  physicians,  who  had  never  made 
the  Bible  a  study,  were  to  certify  to  the  truth  and  effi- 
cacy of  such  a  pretended  discovery?  They  would 
undoubtedly  warn  the  people  to  beware.  It  would  be  a 
dereliction  of  duty  for  them  to  remain  silent ;  and  we, 
on  the  other  hand,  feel,  that  duty  in  reference  to  the 


150 


CONGESTIVE  FEVER. 


health  and  temporal  welfare  of  the  community,  com- 
mands us  to  speak  out  in  words  of  warning  to  the 
people,  and  to  rebuke  such  of  their  spiritual  leaders  as 
travel  out  of  the  way  of  their  profession,  to  enlist  under 
the  banner  of  quackery  in  another." 

I  have  been  led  to  the  statement  of  these  extraordi- 
nary cases,  by  a  sense  of  duty.  It  has  been  said — 
"  thousands  die  of  medicable  wounds  :"  thousands,  I  am 
fully  persuaded,  die  of  fevers  that  might  be  cured.  I 
would  that  the  reader  should  particularly  understand 
that  it  is  not  intended  to  recommend  large  doses  of 
calomel,  no  indeed,  or  any  other  medicine  in  common 
cases.  On  the  contrary,  I  have  always  endeavored  to 
accomplish  the  object  with  as  small  a  quantity  as  pos- 
sible. 

Considerable  attention  has  of  late  been  turned  to  the 
yellow  jessamine,  which  is  cultivated  in  all  portions,  I 
believe,  of  the  Southern  States ;  its  peculiar  action  on  the 
system  was  discovered  accidentally,  and  we  have  used 
it  in  some  few  cases  with  benefit,  and  already  some 
quack  doctor  has  prepared  a  patent  medicine  from  it, 
styling  it  the  "  Electrical  Febrifuge it  is  disguised  in 
this  preparation  by  the  oil  of  winter-green.  From  the 
great  influence  it  possesses  over  most  of  the  fevers  indi- 
genous to  this  climate,  we  are  inclined  to  give  a  full 
description  of  the  plant,  with  its  specific  characters, 
which  description  we  taKe  partly  from  the  Eclectic 
Journal  of  Cincinnati,  Dec.  No.,  1852. 

The  Gelseminum  belongs  to  the  natural  order  Apocy- 
nese,  so  remarkable  for  the  great  activity  of  many  of  its 
genera,  and  the  name  of  the  genus,  given  by  Jussieu,  is 
one  of  the  ancient  names  of  the  jessamine,  and  that  of 
the  species  arises  from  its  evergreen  foliage. 


CONGESTIVE  FEVER. 


151 


Gelseminum  belongs  to  the  Pentandria  Pigymia  of 
Linnaeus,  and  to  the  natural  order  Apocyneae  of  Jus- 
sieu. 

Generic  Characters. — Regular,  calyx  fire  parted,  (the 
sepals  of  this  species  being  furnished  with  bract-like 
appendages,)  corolla  funnel-form,  border  spreading,  fire- 
lobed,  nearly  equal,  capsule  compressed,  flat,  two  par- 
tible, two-celled,  seeds  flat  and  attached  to  the  margins 
of  the  valves. 

Specific  Characters. — The  Gelseminum  Sempervirens, 
is  known  in  the  South  under  the  names  yellow  jasmine, 
wild  jasmine,  and  woodbine.  In  Florida  I  learn  it 
flowers  in  March,  in  Mississippi  in  June,  and  we  have 
seen  it  here  in  April  and  May  flower  sooner.  Its  stem 
is  twining,  smooth  and  glabrous ;  its  leaves  are  oppo- 
site, perennial,  lanceolate,  entire,  dark  green  above, 
paler  beneath,  with  short  petioles.  The  flowers,  which 
are  esteemed  poisonous,  are  yellow,  about  an  inch  long 
and  half  an  inch  wide  at  the  top,  of  a  fine  yellow  color, 
and  have  an  agreeable  odor,  which  perfumes  the  air 
where  they  bloom.  It  grows  luxuriantly,  climbing 
from  tree  to  tree.  According  to  Eaton,  from  whose 
botany  we  have  gleaned  the  above  botanical  notice, 
there  is  a  variety  called  inodorus,  which  has  scentless 
flowers. 

It  is  indigenous  to  this  state,  as  well  as  most  of  the 
Southern  States. 

Medical  Properties. — The  root  is  the  part  used,  and 
the  tincture  is  the  preparation  most  usually  employed, 
and,  as  made,  must  be  a  saturated  tincture.  The  roots, 
in  a  green  state,  well  bruised,  are  introduced  into  a 
suitable  vessel,  and  covered  with  whiskey  or  diluted 
alcohol.     After  standing  two  weeks,  the  tincture  is 


152 


COXGESTIYE  FEVER. 


separated  by  expression  and  filtered.  The  dose  is  from 
ten  to  forty  drops. 

The  Gelseminum  is  stimulant,  tonic,  and  anti-spas- 
modic.   By  its  relaxing  effect,  it  produces  gentle  dia- 
phoresis, and  is  said  by  Dr.  Eogers  and  others  to  be 
narcotic.     I  have  used  it  in  but  few  cases,  but  am 
inclined  to  the  opinion  that  it  possesses  narcotic  pro- 
perties.    Its  effects  in  large  doses,  or  when  too  fre- 
quently repeated,  is  extreme  relaxation,  and  general 
prostration  of  the  whole  muscular  and  nervous  system. 
It  will  suspend  and  hold  in  check  muscular  irritability 
and  nervous  excitement,  with  more  force  and  power 
than  any  known  remedy."     Our  experience  accords 
with  this  statement.    It  is  of  a  bitter  taste,  and  exerts 
its  influence  in  all  febrile  diseases,  which  is  remarkable, 
without  producing  nausea,  vomiting  or  purging.  When 
enough  has  been  given  to  produce  its  specific  effect,  the 
eye  becomes  dimmed,  the  vision  clouded  and  doubled, 
the  head  light  and  dizzy.    When  these  effects  follow 
the  administration  of  the  remedy,  no  more  should  be 
given  until  the  patient  has  entirely  recovered  from  its 
influence.    It  may  be  used  in  all  species  of  fevers,  ner- 
vous and  bilious  headache,  colds,  pneumonia,  ha3inor- 
rhage,  leucorrhoea,  chorea,  enlargements  of  the  spleen, 
and  I  am  confident  it  will  prove  a  valuable  remedy  in 
that  troublesome  disease,  asthma,  and  many  other  dis- 
eases,— its  great  efficacy  is  in  almost  all  forms  of  fever. 
It  should  be  used  with  great  care  and  caution.  The 
root  is  said  to  possess  a  resinous  principle,  which,  when 
extracted  by  pure  alcohol,  will,  in  very  small  doses,  pro- 
duce death.    But  no  such  effect  need  be  apprehended 
from  the  proper  dose  of  the  common  tincture.  There 
is  danger  of  carrying  it  to  such  an  extent  as  to  suspend 


CONGESTIVE  FEVER. 


153 


involuntary  muscular  action,  and  when  this  is  the  case, 
death  must  ensue.  It  is  incompatible  with  no  known 
substance,  and  may  follow  any  preceding  treatment 
with  perfect  safety.  The  dose  is  forty  drops  for  an 
adult,  and  children  in  proportion  to  age  and  tempera- 
ment. It  is  given  either  with  or  without  quinine.  It 
has  been  used  for  chronic  rheumatism,  in  doses  of  forty 
drops,  three  times  a-day,  with  marked  effects.  Three 
or  four  doses,  with  a  mild  cathartic,  will  remove  the 
redness  and  swelling  attending  inflamed  sore  eyes. 
Special  attention  should  be  directed  to  the  general  health 
and  constitution  of  the  patient,  before  giving  this  remedy. 
If  the  bowels  be  constipated,  they  should  be  moved  by 
a  gentle  aperient,  and  kept  in  a  soluble  condition.  It 
requires  double  the  quantity  to  produce  the  effect  on 
some  that  it  does  on  others,  and  should  you  unfortu- 
nately produce  too  great  a  degree  of  relaxation,  you 
should  lose  no  time  in  stimulating  and  toning  up  your 
patient. 

We  have  used  it,  according  to  the  mode  prescribed  by 
Dr.  Hickman,  which  gentleman  has  used  it  for  about  a 
year  in  an  hundred  cases  of  fever,  without,  as  he  says, 
one  solitary  failure.  His  mode  of  preparing  the  tincture, 
is  to  take  the  green  roots,  wash,  and  bruise  them,  then 
place  them  in  a  clean  glass  vessel,  and  pour  good  whiskey 
upon  them  until  they  are  covered,  when  they  are  suffered 
to  stand  and  macerate  for  ten  days,  after  which  they 
are  ready  to  be  strained.  About  thirty  drops  of  this 
tincture  are  given  to  an  adult  every  three  hours  until 
three  doses  are  taken.  In  all  cases  of  fever  he  gives 
from  three  to  six  grains  of  quinine  along  with  this 
tincture  of  jasmine.  It  is  advantageous  to  use  it  along 
with  quinine,  as  it  prevents  the  rush  of  blood  to  the 


154 


YELLOW  FEVER. 


head,  and  is  anti-spasmodic.  It  will  relax  the  nervous 
system  of  itself  for  a  short  time,  but  the  fever  will 
return  again,  hence  I  would  advise  that  it  should  always 
be  given  with  quinine.  This  course  of  treatment  will 
break  up  an  attack  of  remittent  fever  in  from  twelve  to 
twenty  hours,  frequently  sooner,  by  first  giving  some 
mild  cathartic,  either  blue  pill  or  podophyllin.  In  bad 
cases  of  congestive  fever,  or  typhoid,  it  is  necessary  to 
give  a  cathartic  first,  which  will  secrete  the  bile,  and 
then  give  the  jasmine  and  quinine — if  given  as  directed 
no  deleterious  effects  follow ;  it  should  be  given  in  all 
cases  until  the  patient  becomes  drowsy. 

The  effects  of  this  plant  on  the  human  system,  taken 
in  connection  with  its  medico-botanical  relations,  its 
general  application  to  febrile  diseases,  mark  it  out  as 
being  probably  one  of  the  most  valuable  of  our  indi- 
genous remedial  agents,  and  renders  it  well  worthy  the 
investigation  by  the  profession — it  is  a  remedy  that  will 
meet  your  expectations,  when  properly  administered. 

YELLOW  FEVER. 

Having  some  time  since  written  an  article  upon  this 
subject,  at  the  request  of  some  medical  friends,  I  think 
I  can  do  no  better  than  to  insert  it  in  these  pages,  as  my 
opinions  have  only  been  strengthened  since  its  publica- 
tion in  the  New  Orleans  Medical  Journal. 

Epidemic  diseases  generally,  are  chiefly  of  the  acute 
or  febrile  class ;  they  are  apt  to  prevail  in  the  Spring, 
but  frequently  in  the  Summer  and  Autumn;  happily 
for  us,  and  mankind  in  general,  that  our  ignorance  of 
the  causes  of  many  epidemic  diseases  does  not  destroy 
our  interests  in  the  study  of  their  pathology.  If  medi- 
cal gentlemen  would  be  contented  to  look  calmly  into 


YELLOW  FEVER. 


155 


the  many  series  of  events  belonging  to  epidemics,  and 
set  aside  their  hypothesis  and  conjectures,  we  would  not 
be  so  much  at  a  loss  to  account  for  the  causes  as  at  the 
present  day.  The  records  of  pestilential  epidemics  pre- 
sent us  with  various  opinions  and  statements,  and  fre- 
quently as  much  at  variance  as  it  is  possible  for  any  two 
different  theories  to  be ;  truth,  however,  is  sacred,  and 
error  cannot  be  disseminated  without  producing  harm ; 
how  important,  then,  is  the  duty  of  medical  observers 
to  investigate  fairly  and  impartially,  and  to  report  with 
truth  and  fidelity. 

We  have  examined  this  subject  to  some  extent,  (as  to 
the  causes  producing  it  in  this  city,)  and  we  will  content 
ourselves  by  alluding  to  the  most  prominent  facts.  As 
far,  therefore,  as  we  are  enabled  to  form  any  general 
conclusions  in  regard  to  the  circumstances  which  con- 
spire, in  many  cases,  to  produce  a  pestilence,  the  follow- 
ing are  substantially  our  deductions  : — 

First. — Intemperature  of  the  air,  or  peculiarly  irregu- 
lar weather. 

Second. — Local  impurities,  the  result  of  putrifying 
substances,  more  especially  of  animal  matter,  if  located 
in  marshy  situations,  produce  miasma,  which  aggravates 
the  preceding  causes  by  polluting  the  atmosphere. 

Third. — (And  I  think  very  important,)  human  secre- 
tions and  excretions ;  the  latter  become  virulent  by 
accumulation,  and  almost  poisonous  during  a  fever, 
"  which  always,"  says  a  distinguished  author,  "  is  the 
cause  of  the  fever  acquiring  a  degree  of  malignity  which 
is  proportioned  to  the  congregated  mass." 

We  do  not  wish  a  latitudinous  construction  of  this 
sentence,  so  as  to  infer  that  we  are  willing  to  concede  to 
authorities  of  considerable  respectability,  that  the  solu- 


156 


YELLOW  FEVER. 


tion  of  the  question  is  to  be  found  in  all  cases,  in  the 
filth  of  the  town  or  the  state  of  the  sewers ;  though  we 
are  free  to  admit  they  are  great  auxiliaries. 

Exposure — Fatigue — Excesses. — There  can  be  no  doubt 
that  yellow  fever  is  frequently  the  immediate  result  of 
the  operation  of  the  ordinary  occasional  or  exciting 
causes  of  disease;  and  that  persons  exposed  to  the 
essential  poison  of  the  disease,  might  escape,  were  it  not 
for  the  co-operation  of  the  latter  influences.  Dr.  Rush 
states  that  he  did  not  see  a  single  case  in  which  the 
disease  came  on  without  an  exciting  cause ;  such  as 
light  clothing  and  bed  clothes,  sitting  at  doors  after 
night,  a  long  ysdk,  gunning,  and  violent  and  unusual 
exercises  of  any  kind.  Dr.  Hillary,  one  of  the  most 
careful  observers,  says :  66  The  disease  most  readily  seizes 
those  who  use  vinous  or  spirituous  liquors  too  freely; 
and  still  more  readily  those  who  labor  hard  or  use  too 
violent  exercise,  and  are,  at  the  same  time,  exposed  to 
the  influence  of  the  scorching  rays  of  the  sun  in  the  day 
time,  and  soon  after  expose  themselves  too  suddenly  to 
cool  dews  and  damp  air  of  the  night,  and  especially  if 
they  drink  liquor  too  freely.  Dr.  Dereze  says,  that  it 
has  always  been  remarked,  that  during  the  prevalence 
of  yellow  fever,  persons  newly  married  are  constantly 
its  victims.  "  Of  all  the  exciting  causes  of  yellow  fever," 
says  Dr.  Balby,  "the  act  of  coition  is  the  most  powerful. 
How  many  have  we  seen,  seized  by  a  chill  on  leaving 
the  arms  of  pleasure,  terminate  in  a  few  days  their 
career?  How  many,  even,  have  we  seen,  the  victims  of 
a  simple  nocturnal  pollution  ? 

We  find  that  a  great  many  authors  lay  great  stress 
on  the  signs  which  are  the  antecedent  indications  of  an 
epidemic,  "such  as  intemperate  seasons,  and  unusual 


YELLOW  FEVER. 


157 


weather,  (which  I  think  quite  likely)  great  mortality 
among  any  species  of  the  lower  animals,  and  great 
scarcity  amongst  binds/'  the  singular  changes  which 
have  been  observed  to  occur  in  the  common  varying 
disease  of  the  place  before,  during  and  after  an  epidemic, 
the  facts  connected  with  epidemic  pestilence;  and  on 
the  other  hand,  the  exemption  of  those  places  where 
due  attention  has  been  given  to  cleanliness  and  a  ra- 
tional system  of  health  police.  Mortality  among  ani- 
mals very  frequently  follows  intemperature  of  the 
seasons.  In  the  pestilence  that  raged  at  New  Orleans 
in  1819,  "we  are  told  that  cattle  died,  horses,  oxen  and 
cows,  with  rotten  tongues ;  sheep  and  hogs  with  their 
hoofs  dropping  off,  and  calves  with  rotten  ears." 

To  found,  however,  any  truth  in  science,  we  must 
have  strict  recourse  to  our  general  and  impartial  obser- 
vations ;  a  solitary  isolated  fact  is  only  valuable  so  far 
as  it  may  tend  to  establish  general  laws.  There  is  no 
question  in  regard  to  one  fact,  that  at  the  commence- 
ment of  an  epidemic  the  proportional  mortality  is  always 
greatest.  We  have  another  remarkable  fact :  in  all  the 
cities  and  towns  in  Spain  which  suffered  with  yellow 
fever,  they  were,  with  the  exception  of  Cadiz,  extremely 
filthy,  even  disgustingly  so ;  and  a  fact  worthy  of  notice, 
that  Cadiz  escaped  very  lightly,  in  consequence  of  a 
rigid  system  of  police  which  had  been  adopted,  and  the 
result  was,  as  history  testifies,  that  they  seldom  have 
suffered  since.  And  I  icould  most  respectfully  suggest, 
that  if  a  prudent  and  systematic  adoption  of  police  should 
prove  of  benefit  at  the  very  time  of  an  epidemic,  to  lessen 
the  mortality  and  to  mitigate  the  disease,  as  it  has  often 
been  found  to  do,  how  much  more  should  such  measures 


158 


YELLOW  FEVER. 


prove  beneficial  if  practically  adopted  in  any  city,  as  the 
constant  and  most  efficient  means  of  preservation. 

Contagion. — In  regard  to  contagion  I  hold  it  is  not  a 
necessary  incident  to  any  disease  of  this  class.  Medical 
men  themselves,  as  well  as  the  public,  are  worn  out  with 
statements  from  different  authors,  and  "indeed  they 
may  well  wonder  at  the  imperfect  state  of  science  which 
has  not  settled  points  of  so  much  importance." 

During  the  last  fifty  years,  medicine  has  assumed 
more  of  the  character  of  an  exact  science  than  it  held 
before ;  and  of  the  history  of  contagion  little  is  known 
for  the  space  of  a  century  after  its  origin.  In  1545,  we 
are  informed  by  ancient  authorities,  that  Pope  Paul  III. 
convoked  reluctantly  the  Council  of  Trent ;  and  being 
anxious  to  remove  the  Council  to  Bologna,  he  was  not 
slow  in  contriving  means  for  the  accomplishment  of  his 
purpose.  An  epidemic  was  prevailing  in  Trent  at  the 
time  of  the  assembling  of  the  Council,  and  availing 
himself  of  this  circumstance,  the  Pope  caused  it  to  be 
proclaimed  that  the  disease  was  contagious,  and  there- 
fore dangerous  to  the  health  and  lives  of  the  fathers. 
In  this  proclamation  he  found  no  difficulty  in  inducing 
physicians  and  others  to  concur.  A  committee  of  in- 
quiry, composed  of  prelates,  was  formed  by  Cardinal 
Morito,  (I  quote  from  memory,)  who  was  an  artful  man, 
and  easily  controlled  by  his  Holiness ;  and  before  this 
venerable  body,  Frucastorious,  and  many  other  phy- 
sicians, (who,  from  bribery,  says  history,)  being  solemnly 
examined,  testified  to  the  Pope's  opinion.  "  The  con- 
sequence of  this  manoeuvre  was  threefold;  the  Council 
was  removed,  his  Holiness  gained  his  end,  and  the 
belief  in  contagion  established  by  authority  of  the 
church." 


YELLOW  FEVER. 


159 


And  it  is  but  too  true,  from  facts,  that  that  scheme 
of  protection  has  descended,  with  but  slight  modifica- 
tions, to  the  present  time.  It  has  been  sustained  by 
authority  of  the  Romish  Church ;  and  in  modern  days 
it  has  been  sustained  principally  from  this  precedent ; 
for  we  are  bold  to  say,  that  nine-tenths  of  the  physicians 
of  the  present  day  will  accord  with  us  in  saying,  that 
truth  and  science,  from  investigation,  have  afforded  it 
no  support.  To  exhibit  some  of  the  many  ridiculous 
causes  assigned,  and  the  testimony  submitted  on  the 
part  of  those  who  were  anxious  to  establish  the  principle 
of  contagion,  it  may  not  be  amiss  to  recite  a  few  of  the 
facts  from  the  most  enlightened  witnesses.  They  were 
as  follows : — "  A  fur  or  leather  cap,  worn  thirty-five  years 
previously,  by  a  person  with  pestilence,  communicated 
the  disease  to  twenty-five  Germans  in  Verona,  and  de- 
stroyed them  all." 

"  A  feather  bed,  in  which  a  pestilential  subject  had 
lain,  on  being  shaken  up  some  years  afterwards,  in 
Waterslau,  produced  a  fever,  of  which  9,500  persons 
died." 

• "  A  rug,  which  had  been  infected  fourteen  years  before, 
on  being  thrown  out  of  a  window,  sent  its  plague  poison 
abroad,  and  produced  frightful  mortality." 

On  the  authority  of  these  absurd  tales,  says  a  distin- 
guished author,  and  many  others  which  I  could  recite, 
equally  as  incredulous, — (as,  for  instance,  this  :  in  mod- 
ern days  quarantines  are  established  for  forty  days. 
Why  forty  days  ?  Is  it  from  the  fact  that  it  is  the  usual 
time  allotted  to  dog  days  ?  I  presume  it  is  from  the  fact 
that  it  corresponds  with  the  forty  days  lent.)  Upon  all 
this  has  a  judgment  been  passed,  and  a  code  of  laws 
been  established,  which  the  accumulated  experience  and 


160 


YELLOW  FEVER. 


wisdom  of  centuries  have  not  yet  set  aside.  It  seems  to 
us,  in  the  nineteenth  century,  that  it  is  time  for  science 
to  obliterate,  even  from  the  pages  of  the  past,  a  demon 
that  has  even  shackled  commerce.  And  yet  there  are 
not  wanting  individuals  of  distinction,  who  still  endeavor 
to.  maintain  their  truth  and  perpetuate  their  influence. 
And  I  wTill  here  remark,  so  far  as  my  knowledge 
extends,  that  every  candid  and  well  conducted  enquiry 
into  the  hypothesis  of  contagion  has  resulted  unfavora- 
bly to  it.  Dr.  Rush  was  candid  and  honest  enough  to 
recede  from  his  first  position ;  and  it  is  admitted  by  high 
medical  authorities,  that  among  the  former  advocates  of 
contagion  in  the  West  Indies,  scarcely  one  can  be  found 
in  the  present  day. 

Dr.  Bono,  who  resided  in  the  West  Indies  for  a  num- 
ber of  years,  and  whose  opinions  on  yellow  fever  are 
entitled  to  great  confidence,  says :  "  I  have  proved  in 
the  Naval  Hospital  that  the  yellow  fever  cannot,  by 
any  possibility,  be  communicated  from  one  person  to 
another." 

"We  do  not  allow  the  fever  commonly  called  yellow 
fever  to  be  infectious."  This  opinion  is  supported  by 
many  American  authors ;  yet  I  am  not  prepared  to  say, 
if  a  great  number  of  persons  laboring  under  yellow  fever 
in  its  violent  form,  and  crowded  into  an  ill  ventilated 
apartment,  as  on  board  ship,  might  not  create  a  morbid 
atmosphere,  and  if  conveyed  to  a  place  extremely  filthy, 
the  probability  is  that  it  might  find  an  affinity  in  the 
atmosphere  of  that  locality,  and  might  act  as  a  spark  to 
ignite  the  whole  material;  but  we  should  most  rigidly 
observe,  generally,  that  the  great  error  is  in  attributing 
to  contagion,  that  which  should  honestly  be  attributed 


YELLOW  FEVER. 


161 


to  accumulated  causes  of  filth,  and  decomposition  of 
vegetable  and  animal  matter. 

Treatment. — As  regards  the  treatment  of  yellow  fever, 
I  wTould  simply  remark,  that  with  the  mass  of  practi- 
tioners, it  is  as  much  at  variance  as  the  cause.  The 
rationale  of  Mr.  Wilson  I  deem  worthy  of  attention. 
He  admits,  as  I  presume  all  will,  "that  in  many  cases 
the  resources  of  our  art  have  little  influence  in  its  worst 
forms."  He  even  goes  so  far  as  to  say  that  this  fever 
is  utterly  beyond  control;  and,  indeed,  it  is  not  permit- 
ted us  to  be  too  sanguine  as  to  the  efficacy  of  any 
remedy  in  even  a  seemingly  mild  case  of  the  disease." 

It  has  always  been  a  matter  of  astonishment  to  me, 
in  epidemics,  that  no  treatment,  during  their  preva- 
lence, ever  commanded  the  general  assent.  Some  place 
their  reliance  on  active  and  vigorous  depletion,  others 
extol  calomel  to  ptyalism  (salivation.)  The  latter,  in 
the  United  States  and  England,  has  more  advocates, 
probably,  than  any  other.  "Although  M.  Louis  and 
other  distinguished  gentlemen  contend  that  the  liver  is 
the  only  organ  constantly,  and  more  or  less  uniformly 
altered."  The  same  opinion  is  entertained  by  a  very 
distinguished  and  truly  scientific  gentleman  of  Galveston, 
Dr.  A.  Smith,  (if  my  memory  serves  me  right,)  yet  the 
former  contends,  that  "experience  has  sufficiently  proved 
that  no  dependence  is  to  be  placed  on  mercurial  prepar- 
ations of  any  sort." 

The  treatment  of  depletion,  venesection,  &c,  we  hold 
is  of  extreme  doubtful  utility ;  and  as  a  means  of  redu- 
cing the  active  excitement  of  the  first  stage,  and  as  a 
substitute,  in  some  degree,  for  blood  letting,  I  make  use 
of  the  cold  affusion.  Dr.  Dickson,  formerly  of  South 
Carolina,  praises  it  very  highly.  "  Kelief  from  the  pun- 
11 


162 


YELLOW  FEVER. 


gent  heat  of  the  skin/'  he  says,  "  the  tormenting  thirst, 
the  distressing  headache,  the  pain  and  irritability .  of 
stomach,  you  will  never  fail  to  procure.  This  relief,  it 
is  true,  will  be  partial  and  transient;  but  the  remedy 
may  be  repeated  as  often  as  seems  requisite,  without 
danger  or  injury.  The  termination  of  the  chill,  if 
there  be  one,  when  the  face  becomes  flushed,  and  the 
surface  dry  and  hot,  a  condition  almost  characteristic  in 
the  degree  attending  this  form  of  fever,  is  the  moment 
for  affusion.  Seat  your  patient  in  a  convenient  vessel, 
and  pour  rapidly  from  a  slight  elevation,  upon  his  head 
and  shoulders  and  over  his  naked  body,  a  full  large 
stream  of  cold  water,  continuing  it  until  his  face  becomes 
pale,  or  his  pulse  sinks.  I  have  never  yet  seen  any 
unpleasant  consequences  from  it.  The  surface  should 
be  rubbed  dry,  and  the  patient,  on  lying  down,  covered 
so  as  to  be  comfortably  warm."  Upon  the  first  symp- 
toms of  the  disease,  I  recommend  a  warm  mustard 
pedeluvium  (foot  bath)  to  the  extremities,  sinipisms  to 
be  applied  immediately  after,  a  large  one  between  the 
shoulders,  to  assist  in  arresting  the  hot  stage,  and  to 
produce  a  free  determination  to  the  surface.  At  the 
same  time  we  administer  small  portions  of  the  pure 
tincture  of  Aconite,  ten  drops  to  two  or  three  ounces  of 
water,  and  give  a  teaspoonful  every  ten  or  fifteen  min- 
utes until  perspiration  is  produced,  or  the  desired  object 
of  reducing  the  circulation  is  effected.  After  which, 
four  ounces  of  rochelle  salts,  with  or  without  one  gr*  of 
tart.  ant.  (tartar  emetic)  given  in  small  doses  during 
the  twenty-four  hours.  But  if  there  is  an  obstruction 
in  the  gall  ducts,  as  manifest  from  the  absence  of  the 
biliary  secretions,  I  do  not  then  hesitate  to  combine  a 
few  grains  of  sub.  hydrag.  (calomel),  or  podophylline 


YELLOW  FEVER. 


163 


with  a  grain  of  opium,  and  continue  until  biliary  secre- 
tions reappear.  Enemata  we  generally  have  recourse 
to  as  useful  auxiliaries.  Frequently  we  have  seen  the 
disease  localize  itself  upon  the  bowels,  and  commence 
a  termination  by  active  hypercatharsis  (purging)  ;  in 
this  stage  you  will  have  to  resort  to  astringent  injec- 
tions. Quinine  we  commence  with  at  the  outset,  wTith 
10  gr.  doses,  (we  view  this  dose  as  a  sedative,)  with  a 
small  portion  of  sulphuric  acid,  as  the  circumstances  of 
the  case  dictate.  Frequently,  however,  any  treatment 
has  to  be  varied,  from  the  fact,  in  the  majority  of  cases, 
great  irritability  of  the  stomach  is  always  present;  and 
if  cupping,  epispastics  or  sinapisms  fail  to  allay  irritabil- 
ity, we  have  frequently  seen  the  following  prescription 
do  so: 

1^.  Lemon  juice,  Si- 
Sub,  carb.  ammonia,  9ii.  M. 
when  the  effervescence  has  ceased,  add  common  syrup, 
two  ounces,  camp,  mixture,  one  ounce,  and  give  from 
one  to  two  table-spoonfuls  every  three  or  four  hours ; 
frequently  a  drop  or  two  of  kreosote  will  allay  the  irri- 
tability, if  given  in  milk ;  and  as  a  dernier  resort,  and 
I  have  seldom  seen  it  fail,  a  blister  along  the  spine  is  a 
valuable  auxiliary. 

We  would  remark,  that  we  have  modified  our  treat- 
ment in  some  cases,  substituting  oil  for  mercury  or 
podophylline ;  and  we  think  that  it  has  been  attended, 
probably,  with  better  success. 

There  is,  as  I  before  observed,  quite  a  variety  of 
opinion  in  regard  to  the  treatment  of  yellow  fever ;  in 
the  epidemic  of  1848,  in  Houston,  which  was  generally 
mild  in  its  character,  my  friend  Dr.  McCraven  assures 


164 


YELLOW  FEVER. 


me  that  he  treated  two  hundred  cases,  and  administered 
castor  oil  to  remove  the  secretions  from  the  bowels,  and 
only  lost  with  this  treatment  three  cases.  This  cer- 
tainly speaks  well  for  the  practice — but  in  opposition  to 
this,  my  friend,  Dr.  Ewing,  who  is  good  authority, 
treated  a  large  number  of  cases  on  the  mercurial  plan, 
with  eminent  success,  and  assures  me  that  in  the  epi- 
demic of  '39,  which  was  very  malignant  in  its  cha- 
racter, he  tried  both  plans  of  treatment  effectually,  and 
accords  his  opinion  in  favor  of  mercury. 

Some  French  physicians  are  extolling  ice  in  these  two 
forms  of  fever,  (continued  fever  and  yellow  fever,)  they 
apply  it  in  bladders  to  the  head,  in  typhoid,  and  upon 
the  abdomen  to  lessen  the  irritation,  and  to  obviate 
ulceration  in  the  small  intestines,  applied  in  small 
pieces  with  ground  flaxseed  to  the  abdomen,  they  re- 
commend continuing  them  for  eight  or  ten  days,  if  the 
pain  exists. 

In  yellow  fever,  if  applied  on  the  stomach  in  the  febrile 
stage,  it  will  reduce  the  heat  and  thirst,  and  prevent  that 
fluxionary  movement  towards  the  stomach,  that  we  find 
in  this  fever. 

I  find  in  an  European  Medical  Journal,  a  new  remedy 
for  the  yellow  fever.  The  discovery  seems  to  have  been 
made  at  Angostura,  in  Venezuela.  The  remedy  is  the 
plant  vervain  or  vevhena,  which  grows  abundantly  in 
that  region.  The  expressed  juice  of  the  leaves,  given 
in  small  doses  three  times  a-day,  with  an  injection  of 
the  same  every  two  hours,  is  stated  to  be  a  perfect  cure 
of  the  yellow  fever  and  black  vomit,  even  in  their  most 
threatening  stages.  All  the  physicians  of  Angostura 
have  adopted  this  treatment  of  the  disease,  and  they 


SMALL  POX. 


165 


state  that  hardly  any  deaths  occur  under  its  influence. 
This  statement  is  attested  by  the  British  Vice-Consul, 
at  the  above  place. 

The  varieties  of  the  verbena  growing  in  the  warm  and 
temperate  regions  of  the  western  world  are  numerous. 
The  particular  species  referred  to*above,  is  that  known 
to  botanists  by  the  name  of  Verbena  Jamaicensis.  It  is  a 
native  of  the  West  India  Islands,  as  well  as  of  the  con- 
tinent. There  are  two  kinds  of  it,  the  male  and  the 
female ;  the  latter  is  the  one  used  as  above.  It  has 
long  been  known  to  the  Creole  population  of  Spanish 
America,  for  its  medical  virtues.  They  have  used  it  as 
a  febrifuge  and  an  unfailing  specific,  in  cases  of  dysen- 
tery. It  is  generally  given  to  children  as  a  tea,  mixed 
with  sugar  and  milk,  and  is  by  no  means  a  disagreeable 
beverage.  The  expressed  juice  of  the  plant  forms  a 
cooling  purge  for  children,  in  fevers.  The  vermin  is 
likewise  a  remedy  of  imrticular  note  in  sundry  mala- 
dies that  defy  ordinary  medicines.  Sloane  says,  that  a 
decoction  of  it  cures  dropsies;  Hughes,  that  it  is  a 
powerful  deobstruent;  according  to  Barham,  it  is  like- 
wise an  excellent  vermifuge.  And,  having  now  been 
discovered  as  a  cure  for  yellow  fever,  this  shrub  must  in 
future  rank  as  a  still  more  valuable  addition  to  the 
pharmacopiae. 


ERUPTIVE  FEVERS. 

SMALL  POX. 

So  called  in  English,  but  in  medical  Latin,  "  variola.'' 
This  is  an  eruptive  fever,  desseminated  from  contagion, 


166 


SMALL  POX. 


seldom  affecting  persons  more  than  once  during  life — 
there  are  two  distinct  varieties,  generally  divided  as  the 
distinct  and  confluent,  the  different  stages  of  which  are 
the  febrile,  eruptive,  maturative  and  declensive. 

Premonitory  Symptoms. — Before  the  eruption  appears, 
the  symptoms  approximate  very  closely  to  those  that  pre- 
sent themselves  in  any  other  fever — for  instance  we  have 
languor,  vomiting,  severe  pain1  in  the  head  and  loins, 
accompanied  with  drowsiness,  the  symptoms  are  much 
the  same  as  those  you  find  in  continued  fever — there  is 
also  universal  feverislmess,  tenderness  of  the  epigas- 
trium, (region  of  the  stomach)  pain  in  the  loins,  (and 
these  two  symptoms  are  generally  very  intense,) 
quickness  of  pulse.  After  these  symptoms  have  pre- 
vailed for  about  two  days,  small  red  spots  make  their 
appearance,  first  in  the  face,  and  then  generally  over  the 
body — these  spots  rise  into  pimples,  and  on  the  fifth 
day,  counting  from  the  first  fever,  you  have  pustules, 
the  contents  of  which  look  opaque  and  white,  and  seven 
out  often,  if  they  are  large,  are  depressed  in  the  centre. 
On  the  eighth  day  maturation  commences,  counting  as 
before  from  the  first  fever ;  if  the  eruption  be  extensive, 
the  face  becomes  swollen,  the  eyes  are  apt  to  close,  with 
considerable  inflammation  of  the  fauces.  On  the  eleventh 
day  the  pustules  are  at  their  acme ;  inflammation  of  the 
fauces  generally  at  this  period  subsides,  and  the  ex- 
tremities commence  swelling,  first  the  hands :  and  at 
this  time  the  pustules  are  completely  ripe,  (if  I  may  use 
the  expression)  and  maturated.  When  the  pustules 
become  perfect  we  then  have  a  fresh  attack  of  fever,  this 
is  called  the  6  secondary  fever,'  to  distinguish  it  from 
that  which  ushers  in  the  disease,  and  is  styled  the 
*  primary  fever.' 


SMALL  POX. 


167 


Variola  Confluens. — The  other  form  of  the  affection, 
the  pustules  are  very  numerous,  run  into  each  other. 
The  fever  is  decidedly  more  violent,  and  the  symptoms 
more  of  a  typhoid  character ;  the  pulse  is  more  feeble, 
patient  more  prostrated,  and  generally  accompanied 
with  delirium  and  violent  pain  in  the  head. 

Attendant  Symptoms. — The  feverishiress,  in  this  form 
of  the  disease,  is  very  little  lessened  in  the  appearance 
of  the  pocks ;  and  at  the  end  of  the  eruption  it  is  aggra- 
vated very  much.  Secondary  fever,  of  a  very  violent 
character,  comes  on.  The  symptoms  occurring  in  other 
parts  are  also  very  severe.  There  is  an  excessive 
secretion  of  saliva  in  both  forms  of  the  disease,  but 
chiefly  in  the  confluent ;  inflammation  of  the  fauces 
decidedly  more  aggravated  than  in  the  distinct  va- 
riety. We  have  sometimes  diarrhoea  as  an  attendant, 
dark  colored  spots  between  the  pustules,  bloody  urine, 
and  sometimes  bloody  evacuations,  frequently  an  exuda- 
tion, from  the  body,  of  a  very  offensive  smell.  The  con- 
sequences frequently  of  this  form  are  terrible,  such  as 
phthisis,  (consumption)  blindness,  and  ulceration  of  the 
intestines. 

Treatment. — In  the  first  form  of'  the  disease,  that  of 
distinct  small  pox,  there  is  nothing  peculiar  in  the  treat- 
ment ;  the  regimen  should  be  light,  ventilation  free,  a 
mild  aperient  once  or  twice  a  week ;  if  pain  in  the  head, 
cup  the  temples,  if  pain  in  the  chest  or  abdomen,  cup 
over  those  regions ;  his  room  should  be  kept  dark,  and 
he  should  lie  on  a  mattrass.  .  There  is  no  harm  in  cold 
or  tepid  ablution,  provided  the  body  is  hot — the  utmost 
cleanliness  should  be  observed — if  the  fever  is  great  it 
would  be  well  to  wash  the  patient  with  a  solution  of  the 
chlorides,  and  use  them  freely  around  the  bed. 


168 


SMALL  POX. 


In  the  confluent  variety,  where  the  symptoms  assume 
the  typhoid  form,  the  treatment  consists  in  the  selection 
of  those  remedies  and  in  the  use  of  that  diet  which  are 
best  calculated  to  sooth  and  allay  the  disturbances,  based 
in  debility,  which  are  met  with  in  this  form.  To  effect 
this  you  will  resort  principally  to  mild  nourishing  food, 
to  the  administration  of  stimulants,  as  the  sesqui-carbo- 
nate  of  ammonia,  ether,  &c,  and  occasionally  to  the  use 
of  tonics,  especially  quinine  and  ferruginous  prepara- 
tions. The  points,  however,  on  which  to  place  great 
reliance,  are  the  local  application  of  powdered  camphor 
to  all  the  parts  where  the  irritation  is  very  great, 
especially  around  the  throat  when  swollen,  and  the  free 
use  of  .some  absorbing  powder  to  all  the  surfaces  of  the 
body  covered  with  the  eruption,  the  powder  used  gene- 
rally consisting  of  calamine. 

Prevent  Pitting. — My  experience  has  been  too  limited 
to  state  the  most  effectual  mode.  Some  recommend 
Kentish  ointment,  others  puncturing  the  pustules  and 
touching  with  nitrate  silver  solution,  washing  with  milk 
and  water.  The  chloride  of  soda  as  a  wash  is  also 
highly  extolled.  Some  use  sulphur  ointment;  the 
collodion  or  gun  cotton  is  highly  recommended,  but  we 
think  the  mercurial  plaster  has  advantages  over  either 
of  the  other  remedies,  not  that  it  prevents  pitting,  but 
that  it  lessens  the  liability  to  it.  Independently,  how- 
ever, of  its  influence  in  this  respect,  the  application  of 
the  mercurial  plaster  to  the  face  is  valuable  in  some 
cases  with  a  view  of  moderating  inflammation.  Some 
use  the  strong  mercurial  ointment,  whilst  others  rub  it 
down  with  an  equal  portion  of  lard.  To  use  either, 
spread  it  upon  a  piece  of  thick  muslin  shaped  like  a 
mask,  and  then  carefully  apply  it  to  the  forehead  and 


SMALL  POX. 


169 


face ;  apply  it,  if  possible,  before  the  fourth  day  of  the 
eruption. 

A  very  distinguished  author  speaks  in  warm  terms  of 
macrotin  as  a  valuable  remedy  in  this  disease,  says  it 
should  be  given  during  the  whole  course  of  the  disease. 
It  seems  to  divest  it  of  its  malignant  character;  he 
asserts  he  never  lost  a  case  of  small  pox  where  this 
medicine  was  used  thoroughly  from  the  beginning ;  and 
during  the  winter  of  1849  and  1850,  he  treated  from 
fifty  to  one  hundred  cases,  some  of  which  were  of  the 
most  severe  confluent  ?dnd.  The  dose  is  from  one- 
fourth  to  one  grain,  to  be  given  once  in  three  or  four 
hours,  until  the  proper  symptoms  of  the  medicine  appear. 

We  have  extracted  from  a  late  number  of  the  London 
Lancet,  a  new  discovery  for  the  treatment  of  small  pox, 
scarlatina  and  measles,  the  article  was  written  by  a 
"  member  of  the  Koyal  College  of  Surgeons,  who 
vouches  for  it  as  a  6  medicine  that  will  effect  a  revolu- 
tion in  the  healing  art,  as  regards  the  prevention  and 
cure  not  only  of  small  pox,  but  also  of  measles  and 
scarlatina,  however  malignant  the  type,  in  a  manner 
more  efficient  and  extraordinary  than  could  ever  have 
been  hitherto  anticipated  even  by  the  most  ardent  phi- 
lanthropist/ 

"  On  the  first  appearance  of  fever  or  irritation  usher- 
ing in  attacks,  whether  occurring  in  families  or  large 
communities,  the  subjoined  mode  of  treatment  should  at 
once  be  entered  on  :  take  one  grain  of  powdered  fox- 
glove or  digitalis,  (valuable  in  the  ratio  of  its  green- 
ness— the  dark  should  be  rejected,)  and  one  of  sulphate 
of  zinc,  (this  article  is  commonly  known  as  white 
vitriol).  These  should  be  rubbed  thoroughly  in  a 
mortar  or  other  convenient  vessel,  with  four  or  five 


1 70  VARICELLA. 

■m 

drops  of  water;  this  done,  a  noggin  (or  about  four  ounces) 
more  of  water,  with  some  syrup  of  sugar,  should  be 
added.  Of  this  mixture,  a  table-spoonful  should  be 
given  an  adult,  and  two  tea-spoonfuls  to  a  child,  e very- 
second  hour,  until  symptoms  of  disease  vanish. 

"  Thus  conducted,  convalescence,  as  if  by  magic,  will 
result.  The  rapidity  of  an  event  so  auspicious,  will 
equally  delight  and  astonish.  It  may,  however,  be 
necessary  further  to  note,  that  should  the  bowels  be- 
come obstructed  in  progress  of  the  disease,  an  evil  by  no 
means  common,  then  a  drachm  of  the  compound  powder 
of  jalap  (formed  of  two  parts  cream  of  tartar  with  one 
of  jalap,)  and  one  grain  of  the  herb,  treated  as  above, 
formed  into  a  pastil  with  syrup  or  sugar,  should  be  given 
to  an  adult,  and  half  the  quantity  to  a  child.  This 
simple  medicine  shuts  out  every  other  form  or  article 
whatever,  as  totally  unnecessary,  if  not  pernicious. 

"  The  methodus  medendi  of  these  medicines,  capable 
of  effecting  results  so  gigantic,  remain  now  only  to  be 
given,  and  appears  to  be  as  follows :  The  herb,  by  its 
anti-febrile  properties,  lays  hold  at  once  of  the  fever, 
the  prolific  source  of  wo,  which  it  immediately  strangles, 
while  the  zinc  acts  the  part  of  a  tonic,  instantly  restor- 
ing the  equilibrium." 

VARICELLA. 
In  common  language  called  the  chicken  pock  or  swine 
pock,  in  general,  it  requires  no  treatment.  Some  con- 
tend, however,  that  varicella  is  nothing  more  than  a 
modified  form  of  small  pox,  and  various  reasons  are 
assigned  for  this  opinion.  There  are  two  varieties  of 
varicella ;  in  the  chicken  pock,  the  vesicles  are  small, 
elevated,  and  contain  a  colorless  fluid.    In  the  other 


MEASLES.  171 

form  or  swine  pock,  the  vesicles  are  large,  soft,  and 
broader  at  the  base,  the  fluid  they  contain  is  limpid  at 
first,  but  soon  assumes  a  milky  appearance.  Sometimes 
the  symptoms  indicate  treatment,  in  which  event  the 
course  advised  for  variola  is  equally  applicable  here. 

EUBEOLA. 

Was  formerly  apjilied  to  scarlet  fever  and  measles  in 
common,  but  it  is  now  restricted  to  measles. 

Contagion  and  Infection. — In  our  humble  opinion,  this 
is  both  a  contagious  and  infectious  disease,  affecting  in 
this  chmate,  children  and  adults  with  almost  the  same 
severity ;  the  disease  is  inflammatory,  affecting  at  once 
the  skin  and  gastro-pulmonary  mucous  membrane  ;  in 
which,  after  catarrhal  fever  has  continued  about  three 
days,  a  rash  appears  on  the  skin,  at  first  in  small  stig- 
matized dots,  not  unlike  flea  bites;  which  presently 
coalescing,  form  patches  of  a  crescentic  or  semi-lunar 
form ;  first  on  the  face,  and  thence  spreading  gradually 
downwards  over  the  whole  of  the  body  and  limbs,  at 
the  end  of  four  days  disappear  by  desquamation  of  the 
cuticle.  In  short,  the  symptoms  which  usher  in  an 
attack  of  measles,  are  the  symptoms  of  coryza  and 
catarrh  ;  we  have  another  variety  in  this  climate,  which 
is  accompanied  with  severe  diarrhoea,  indicating  a 
simultaneous  affection  of  the  mucous  membrane  of  the 
intestines  ;  which  form  is  very  malignant  in  its  charac- 
ter— the  symptoms  of  the  two  varieties  are  so  well 
characterized,  having  very  peculiar  symptoms,  which  I 
think  no  one  can  mistake. 

Sequelae. — When  the  measles  are  over,  they  frequently 
give  rise  to  a  variety  of  pulmonary  diseases,  even  phthisis 
(consumption,)  and  I  have  seen  cases  that  I  thought 


172 


MEASLES. 


gave  rise  to  tubercles — but  an  important  sequela  after 
measles,  in  this  climate,  is  a  chronic  diarrhoea,  fre- 
quently of  an  inflammatory  character;  and  we  have 
seen  diseased  mesenteric  glands  as  the  result.  And 
these  sequelae  are  frequently  followed  by  a  chronic 
cutaneous  affection,  such  as  boils,  porrigo,  etc. ;  there  is 
really  no  calculating  the  ills  that  measles  sometimes 
leave  behind. 

There  are  three  varieties  spoken  of  by  authors, — 

1st.  Rubeola  Sine  Catarrh. 

2d.  Rubeola  Nigra. 

3d.  Rubeola  Patrida,  (this  latter  form  we  have  never 
witnessed.)  You  will  find  in  the  first  form  of  this  fever, 
that  frequently  eruption  appears  upon  the  mouth  and 
throat,  and  in  negroes  it  is  the  spot  in  which  we  are 
able  to  detect  the  eruption. 

This  disease  resembles  very  much  scarlet  fever,  and 
those  who  are  not  familiar  with  both,  may  find  some 
difficulty  in  making  a  diagnosis,  but  if  due  attention  be 
paid,  the  distinct  difference  is  very  clear.  You  can  dis- 
tinguish this  from  the  latter  affection,  by  the  time 
intervening  between  the  primary  fever  and  the  rash, 
by  the  character  of  the  rash,  and  also  by  the  sequelae — 
the  eruption  of  measles  shows  itself  on  the  fourth  day 
of  the  fevers,  whereas  in  scarlet  fever  on  the  second 
day.  A  marked  difference  is  observed  in  the  peculiar 
character  of  the  rash,  in  measles  it  is  crescent  shaped, 
while  that  of  scarlet  fever  is  diffused  and  irregular; 
the  rash  of  measles  has  a  raspberry  color,  that  of  scarlet 
fever  a  deeper  red. 

Prognosis. — In  regard  to  this,  a  great  many  circum- 
stances present  themselves,  such  as  the  character  of  the 
epidemic,  the  type  of  fever  prevailing  at  the  time,  a  wet 


MEASLES. 


173 


or  dry  season,  (dry  being  decidedly  the  most  favorable,) 
and  whether  the  disease  follows  other  infantile  dis- 
orders. 

The  most  prominent  circumstances  denoting  danger, 
are  unusual  violence  of  the  eruption,  spasmodic  twitch- 
ings  or  convulsions,  the  backward  appearance  of  the 
eruption,  especially  if  it  be  of  a  dark  livid  color ;  or,  if 
the  thoracic  or  abdominal  organs  be  implicated — severe 
headache,  petechiae,  &c. 

Treatment. — In  regard  to  the  treatment  of  this  dis- 
ease, great  discrepancy  of  opinion  exists;  I  am  tho- 
roughly persuaded,  both  from  my  own  experience  and 
my  .observation,  of  the  practice  of  others,  is  too  uni- 
formly active  when  the  eruptive  fever  is  developed. 
An  active  antiphlogistic  treatment,  when  there-  is  no 
complications  of  internal  local  inflammations,  is  uncalled 
for.  and  in  my  opinion  decidely  injurious,  even  though 
great  febrile  excitement  should  present  itself  in  the 
eruptive  fever. 

When  the  fever  is  regular,  without  any  great  degree 
of  violence,  and  uncomplicated  with  inflammation  or 
congestion,  we  should  only  employ  a  gentle  remediate 
treatment — keep  the  bowels  in  a  soluble  condition  by 
laxatives,  drinking  freely  of  diluent  drinks,  and  if 
necessary,  using  some  mild  ptisans — such  as  sage, 
eupatorium,  camomile,  balm,  &c.  If  a  high  grade  of 
fever  presents,  ipecac,  and  nitre  should  be  given  in 
small  quantities.  In  such  cases  we  frequently  prescribe 
the  following : 

Spirit  mindereri,    Si. — (Solution  acetate  of  amm.) 

 Nitre  dulc,    5ii. — (Spirits  nitre.) 

Vim  ipecac,  5iss. 

Syrup,  lemonis,  Siss. 


174 


MEASLES. 


Mix  and  give  a  tea-spoonful  every  hour  or  two. 
Some  use  instead  of  the  syrup  lemonis,  the  camphor 
julep,  which,  however,  I  do  not  think  is  any  way 
superior  to  my  original  prescription. 

In  case  the  measles  should  suddenly  disappear,  (or 
in  common  parlance  'go  in,')  it  will  be  necessary  to 
apply  mustard  plasters  to  the  legs  and  arms,  rub  the 
body  with  flannels  saturated  with  warm  brandy,  and 
apply  warm  poultices  and  bottles  filled  with  hot  water 
to  the  feet  and  hands.  If  inflammation  of  the  chest 
should  supervene,  you  will  find  a  warm  bath  strongly 
impregnated  with  salt,  a  most  valuable  remedy.  If 
the  case  should  prove  obstinate,  then  in  addition  to  the 
above  means,  we  should  give  gently  stimulating  drinks, 
and  the  following  remedy  will  prove  useful  in  cases  of 
this  character. 

1^.    Carbonatis  ammonia,  3i. 
Pulv.  gum  arabic,  siss. 
Sach.  albi  (loaf  sugar,)  3i. 
Tinct  opii,  9ii. 
Water,  5iv. 
Give  a  tea-spoonful  or  two,  every  hour  or  two. 

If  the  symptoms  manifest  a  tendency  to  a  malignant 
form,  then  opiates  are  sometimes  necessary,  and  should 
be  continued,  with  a  saline  diaphoretic  at  bedtime,  but 
should  not  be  given  unless  the  patient  is  very  restless. 
If  diarrhoea  or  cough  become  troublesome,  the  syrup  of 
poppies  will  generally  meet  your  wants ;  a  teaspoonful 
or  two  given  occasionally,  according  to  the  violence  of 
the  symptoms,  and  the  patient's  age. 

During  the  course  of  the  disease,  keep  the  bowels  in 
a  soluble  condition,  obviate  costiveness  by  gentle  purga- 


SCARLATINA. 


175 


tives,  and  for  this  purpose  I  am  in  the  habit  of  adminis- 
tering the  syrup  of  rhubarb.  If  there  should  be  diffi- 
culty of  breathing,  a  mustard  or  blister  plaster  applied 
over  the  chest,  or  between  the  shoulders,  has  often 
proved  a  valuable  remedy. 

Patients  recovering  from  measles  should  not  be  per- 
mitted for  some  time  to  expose  themselves  to  the  cold 
air,  as  asthma  and  consumption  are  frequently  the  con- 
sequences of  such  imprudence.  We  append  two  favorite 
recipes ;  the  safflower  mixture  will  be  found  serviceable 
in  assisting  in  bringing  out  the  measles  when  they  have 
subsided  too  soon,  or  gone  in. 

ty.    Safflower,  5ii,  (Bastard  Saffron,) 
Boiling  water,  one  pint. 

Infuse  and  strain.  A  domestic  remedy  to  bring  out 
the  eruption. 

The  spermaceti  mixture  is  a  valuable  remedy  when 
the  cough  is  troublesome  : — 

ty.    Spermaceti,  gii. 
Sugar,  ohi. 
Paregoric  elixir,  flgss. 
Water,  n^viii. 

Rub  the  spermaceti  and  sugar  together  with  the  yolk 
of  an  egg ;  add  the  water  and  paregoric  gradually.  A 
table  spoonful  several  times  a  day. 

See  smallpox,  last  paragraphs. 

SCARLATINA. 

This  is  the  next  disease  which  claims  our  most  pro- 
found consideration,  and  in  plain  English  called  scarlet 
fever. 


176 


SCARLATINA. 


This  disease  the  young  practitioner  will  sometimes 
confound  with  measles ;  and,  as  I  have  pointed  out  the 
distinction  under  the  head  of  measles,  I  deem  it  super- 
fluous to  repeat  it  here.  Not  until  as  late  as  1793  was 
scarlet  fever  separated  from  measles;  Dr.  Nithering 
published  an  article  about  this  time,  and  was  the 
first  to  make  a  correct  division  of  these  diseases. 

Symptoms. — This  disease  is  marked  by  a  scarlet- 
colored  efflorescence  of  the  skin;  and  some  authors 
divide  it  into  four  varieties,  which  we  deem  too  complex 
for  general  practice.  In  the  mild  form  of  the  disease 
we  have  coldness  and  shivering,  to  which  succeed  heat, 
thirst,  and  an  accelerated  pulse ;  the  mouth  and  fauces 
have  not  the  same  appearance  as  the  skin.  These 
symptoms  last  for  about  two  days ;  and  on  the  second 
day,  generally,  the  eruption  appears  in  some  parts; 
but  occasionally  you  will  find  a  case  where  the  erup- 
tion will  not  take  place  till  the  third,  fourth,  fifth 
or  sixth  day;  and  when  it  makes  its  appearance  it 
continues  for  about  five  days. 

It  is  asserted  that  the  interval  between  exposure  and 
the  appearance  of  the  affection  is  greater  in  adults  than 
in  children. 

In  the  most  simple  form  of  the  disease  the  fever  is 
very  moderate.  In  about  twelve  hours  after  the  first 
fever,  a  quantity  of  red  spots  appear  on  the  neck  and 
face,  and  in  twenty-four  hours  will  spread  over  the 
whole  body.  On  the  second,  or  at  furthest  on  the 
third,  the  efflorescence  has  covered  the  whole  body,  and 
more  particularly  the  fingers.  The  eruption,  as  we 
have  before  said,  appears  on  the  second ;  on  the  third  it 
has  extended  itself  over  the  whole  body,  and  on  the 
fourth  the  redness  is  at  its  height.    On  the  fifth  day  it 


SCARLATINA. 


177 


commences  declining;  on  the  sixth  day  it  is  indistinct, 
and  on  the  seventh  generally  no  sign  of  it. 

Tongue. — The  papillae  of  the  tongue  become  enlarged, 
and  they  are  easily  to  be  seen  through  the  dry  mucus 
with  which  it  is  loaded ;  it  looks  as  if  a  pungent  sub- 
stance, such  as  cayenne,  had  been  sprinkled  upon  it. 

There  is  at  times  considerable  redness  of  the  eyes, 
but  no  intolerance  of  light,  and  no  secretion  of  tears. 

If  the  disease  be  at  all  severe,  we  have  discharge 
from  the  ears,  and  frequently  glandular  enlargements. 
After  mild  scarlet  fever  general  dropsy  very  frequently 
follows,  but  the  discharge  from  the  ears  and  suppuration 
of  the  glands  occur  after  the  severe  form  of  the  disease. 

Another  variety,  called  scarlatina  anginosa,  is  marked 
by  the  efflorescence  extending  itself  to  the  mouth  and 
fauces.  It  is  accompanied  with  headache;  sometimes 
delirium  and  great  restlessness.  The  throat  feels  sore, 
the  patient  hoarse,  great  difficulty  in  swallowing;  in 
this  variety  the.  tongue  is  very  red,  especially  at  the 
sides  and  the  extremity;  the  papillae  are  greatly  in- 
creased in  length.  In  the  more  severe  form  of  this 
variety,  the  eruption  frequently  does  not  appear  until 
the  third  day,  but  increases  to  a  great  degree  of  inten- 
sity. About  the  fifth  or  sixth  day,  the  redness  recedes 
from  the  surface  gradually,  the  skin  becomes  rough  and 
pale,  and  a  brown  color  succeeds,  and  the  patient  gra- 
dually becomes  convalescent.  It  sometimes  happens, 
however,  that  after  a  few  days  amendment,  unaccount- 
able languor  and  debility  are  felt,  followed  by  stiffness 
in  the  limbs,  disturbed  sleep,  disrelish  for  food,  accele- 
rated pulse,  scarcity  of  urine,  and  dropsical  swellings. 
In  cases  of  a  very  malignant  type,  in  addition  to  the 
common  symptoms,  there  are  great  heat,  nausea,  and 
12 


178 


SCARLATINA. 


vomiting,  with  a  small,  quick  pulse,  and  frequent  and 
laborious  breathing.  Ulcerations  appear  on  the  tonsils 
and  adjoining  parts,  covered  with  dark  sloughs,  and 
surrounded  by  a  livid  base.  Delirium  arises,  a  debili- 
tating diarrhoea  comes  on,  and  not  unfrequently  hae- 
morrhage from  the  nose,  mouth,  and  bowels  occur.  It 
resembles  very  closely  what  is  termed  the  malignant  or 
ulcerous  sore  throat. 

We  recapitulate  and  condense  the  four  varieties : — 

1st.  Scarlatina  Simplex. — In  the  most  simple  form 
of  scarlet  fever,  the  fever,  is  seldom  of  an  active  kind. 
The  cutaneous  efflorescence  appears  in  the  usual  man- 
ner; but  there  is  no  inflammation  of  the  mucous  mem- 
brane of  the  throat. 

2d.  Scarlatina  Anginosa. — In  this  variety  there  is 
greater  febrile  excitement;  and  the  general  symptoms 
are  farther  complicated  by  inflammation  of  the  fauces. 

3d.  Scarlatina  Maligna. — The  symptoms  are  more 
aggravated  in  their  character.  The  fever,  which  is  of 
a  typhoid  type,  with  great  depression  of  the  vital  pow- 
ers, is  generally  accompanied  with  considerable  inflam- 
mation of  the  throat,  which  sometimes  becomes  gan- 
grenous, accompanied  with  tumefaction  of  the  parotid 
and  cervical  glands,  and  acrimonious  discharge  from  the 
nostrils  and  ears. 

4th.  Scarlitina  Faucium. — In  this  variety  the  efflor- 
escence does  not  appear  upon  the  skin ;  but  is  confined 
to  the  mucous  membrane  of  the  mouth  and  throat. 

Causes. — Scarlet  fever  is  evidently  contagious,  and  it 
can  be  communicated  by  being  near  a  person  laboring 
under  it;  and  it  is  therefore  infectious. 

Prognosis. — In  scarlatina  simplex,  the  great  danger  to 
be  apprehended  is  internal  local  inflammation,  or  the 


SCARLATINA. 


179 


supervention  of  anasarca,  when  the  desquamation  of  the 
cuticle  (skin)  is  completed.  You  must  recollect  that 
when  it  prevails  as  an  epidemic,  the  mildest  cases  some 
times  assume  the  most  malignant  form. 

In  scarlatina  anginosa,  the  danger  to  be  judged  of  is 
in  the  extent  and  severity  of  the  local  inflammation;  in 
this  variety  there  is  a  general  tendency  to  terminate  in 
resolution.  If  the  air-tubes  are  involved,  and  the  mucous 
membrane  of  the  fauces  presents  a  dark  livid  aspect, 
the  case  will  be  apt  to  terminate  fatally.  Early  deli- 
rium a  very  unfavorable  sign. 

Treatment. — Every  scientific  physician  will  admit  that 
this  is  a  very  dangerous  disease;  and  yet  while  we 
assert  in  its  mild  form  no  particular  danger  may  be 
apprehended,  yet  you  should  commence  with  energetic 
and  prompt  remedies,  and  pursue  them  assiduously 
until  convalescence  is  perfect.  My  usual  mode  of  treat- 
ing scarlet  fever  has  been  very  simple.  I  commence  by 
dissolving  two  table  spoonfuls  of  table  salt  in  about  four 
ounces  of  milk  warm  vinegar,  of  this  I  give  one-fourth 
every  ten  minutes,  until  it  acts  as  an  emetic  or  cathar- 
tic. This  I  generally  repeat  for  about  two  days,  at  the 
same  time  I  use  a  strong  cold  salt  bath,  and  if  the  skin 
is  dry  and  hot,  I  repeat  it  every  hour.  When  the  tem- 
perature of  the  skin  becomes  natural,  a  warm  salt  bath 
should  be  substituted  for  the  cold.  The  heat  of  the 
body  is  generally  so  great  that  no  danger  need  be  appre- 
hended from  cold  effusion.  The  disease  has  certainly 
been  cut  short  by  taking  a  patient  out  of  bed  and  pour- 
ing cold  water  upon  him.  It  should  be  done  oftener 
than  it  is ;  but  from  its  appearing  a  violent  measure, 
few  have  the  firmness  to  test  its  efficacy.  'If  this  is  not 


180 


SCARLATINA. 


done,  the  body  should  be  thoroughly  and  frequently 
sponged  with  cold  water  and  salt. 

Cleanliness  and  fresh  air  should  be  particularly  at- 
tended to — as  little  covering  as  possible — his  drink 
should  be  water,  and  no  food  beyond  milk  and  water, 
and  the  bowels  should  be  kept  in  a  soluble  condition. 
Dr.  Waller,  in  an  able  article,  recommends  the  cold 
water  to  be  alternated  with  lard,  this  latter  to  be 
applied  to  the  whole  body  frequently. 

Throat  and  Head. — These  are  the  chief  parts  that 
suffer  in  this  disease.  The  application  of  leeches  (if  they 
can  be  procured,)  around  the  throat  or  about  the  head, 
is  generally  of  great  service. 

In  the  second  and  third  varieties  we  frequently  have 
very  considerable  sloughs.  These  are  always  best  treat- 
ed by  gargles  of  the  chloride  of  soda  or  lime.  The  more 
intense  the  gangrenous  tendency,  the  stronger  must  be 
the  gargle:  In  ordinary  cases  a  gargle  composed  of  two 
ounces  of  the  common  solution,  to  a  half  pint  of  water, 
is  found  strong  enough;  in  violent  cases  it  may  be 
applied  much  stronger  than  this;  if  there  is  any  diffi- 
culty in  the  application  of  the  gargle,  you  can  use  a 
syringe  and  inject  into  the  throat.  If  any  should  be 
swallowed  it  will  do  no  harm.  We  have  used,  in  the 
first  stage,  a  solution  of  caustic  to  the  throat,  once  a  day, 
and  we  have  found,  in  the  suppurative  stage,  that 
administering  creosote  internally,  say  three  drops  in  the 
twenty-four  hours,  is  very  beneficial.  I  have  also  used 
a  gargle  of  creosote,  six  drops  to  the  ounce  of  water, 
three  or  four  times  a  day,  and  think  highly  of  it.  We 
see  the  diluted  pyroliyneous  acid  highly  recommended  as 
a  gargle  in  this  disease;  and  my  friend,  Dr.  Hopkins,  of 


SCARLATINA. 


181 


Leon,  speaks  highly  of  it.  You  put  a  teaspoonful  of  the 
acid  obtained  from  the  shops  into  a  wine  glass  of  water, 
and  gargle  frequently  with  it.  I  am  inclined  to  think 
very  favorably  of  this  remedy. 

As  a  local  application  to  the  throat  in  the  angenose 
form,  you  will  find  cod  liver  oil  applied  three  times  a 
day,  a  valuable  assistant. 

Hoarseness  and  dry  state  of  the  larynx,  before  or 
during  convalescence,  give  from  five  to  ten  drops  of 
balsam  copaibce  on  a  little  sugar,  three  times  a  day. 
After  the  patient  gets  up,  great  care  is  necessary  to  pre- 
vent taking  cold.  The  pulv.  jalap  compound,  will 
generally  keep  down  or  remove  dropsical  effusion  or 
anasarca,  if  that  state  supervene. 

Stimuli — "If  the  disease  show  a  very  considerable 
gangrenous  tendency  hi  the  throat,  and  the  pulse  be 
very  soft  and  feeble,  we  have  only  to  treat  it,  generally, 
as  we  would  treat  any  case  of  typhus  fever.  Sesqui- 
carbonate  of  ammonia,  is  a  good  remedy  in  this  stage, 
barks  and  sulphuric  acid  and  wine,  are  all  beneficial. 

Prophylactics. — A  German  physician,  Dr.  Hahneman, 
of  Leipsic,  recommends  belladonna  for  the  purpose  of 
preventing  the  disease,  he  says,  "  if  we  take  two  grains 
of  the  extract  of  belladonna,  and  dissolve  them  hi  one 
ounce  of  cinnamon  water  or  pure  water,  and  give  two 
minims  of  this  solution  to  a  child  a  year  old,  or  another 
minim  or  two,  according  to  the  age  of  the  child,  we  may 
prevent  the  disease."  I  have  investigated  the  theories 
of  Dr.  Hahneman,  "  Homoeopathy,"  with  great  care,  and 
while  I  have  considerable  regard  for  some  of  the  reme- 
dies, I  must  confess  that  this  article,  as  a  prophylactic, 
has  never  met  my  expectations,  and  I  am  inclined  to  re- 
gard it  like  many  other  of  his  specifics, extremely  fanciful. 


182 


SCARLATINA. 


We  append  some  recipes  that  we  have  used  in  some 
forms  of  scarlatina,  with  advantage : 
Ipecacuanha,  5ss. 
Boiling  water,  sufficient 
to  obtain  six  ounces  of  infusion,  strain  and  add 
Hyponitrous  ether,  3i. 
Extract  of  juniper  berries,  gi. 
Mix.    Dose. — A  spoonful  every  two  hours,  in  the 
dropsical  swellings  consecutive  to  scarlatina. 
Another  : — 

I^.    Tartrate  of  potassa,  3i. 
Nitrate  of  potassa,  5ss. 
Manna,  Si. 
Decoction  of  dandelion,  Svi. 
Mix.    Two  tea-spoonfuls  every  two  hours,  in  dropsy 
consecutive  to  scarlet  fever. 

In  ulcerations  in  the  anginose  variety,  thai  following 
gargle  is  highly  recommended  by  good  authority : 
^.    Solution  of  acetate  of  Ammonia, 
Honey  of  roses,  aa.  Si- 
Elder  water,  Sviii. 
Use  a  small  portion  as  a  gargle,  frequently. 

"We  have  used  the  preparations  of  belladonna  with 
advantage. 

A  preparation  recommended  by  Radius,  and  which 
my  friends  Drs.  Bryan  and  Rogers  speak  of  in  the 
highest  terms,  as  follows  : 

Jfy.    Chlorine  water,  5ii. 
Strawberry  water,  Siss. 
Quince  mucilage, 
Syrup  of  mallows,  aa. 
Mix.    A  tea-spoonful  to  children,  every  2  hours. 


« 

SCARLATINA. 


183 


Of  late  the  baptisia  tinctoria,  (wild  indigo,)  has  been 
used  in  the  form  of  decoction  or  syrup,  in  this  disease, 
with  much  advantage,  and  it  may  be  used  in  all  cases 
where  there  is  a  tendency  to  putrescency.  "  It  acts 
powerfully  on  the  glandular  and  nervous  systems,  in- 
creasing the  glandular  secretions,  and  arousing  the  liver 
especially,  to  a  normal  action ;  and  is  very  efficient  in 
the  atonic  varieties  of  acute  rheumatism  and  pneu- 
monia." 

I  was  assured  by  my  friend  Dr.  R.  Baldwin,  of  Win- 
chester, Va.,  a  practitioner  of  thirty  years  standing,  and 
who  has  encountered  scarlet  fever  in  every  form  and 
variety,  that  his  sole  reliance  of  late,  was  Watson's 
Chlorine  Mixture, — give  table-spoonful  every  few  hours. 

Where  you  have  a  dropsical  affection,  especially 
ascites  (dropsy  of  the  abdomen),  and  dropsy  super- 
vening upon  scarlet  fever  or  other  exanthematous  dis- 
eases, I  would  advise  you  to  try  the  "  Hydragogue 
tincture." 

ty.    Take  elder  bark,  bruized,  lib. 

Sherry  wine,  1  gallon.    Macerate  for 
fourteen  days,  express  and  filter  through  paper. 
Dose. — Two  ounces  three  or  four  times  a  day. 

This  preparation  can  be  made  for  use  immediately, 
by  digesting  the  articles  with  heat  for  an  hour. 

Scarlet  fever  has  baffled  most  medical  men  in  its 
treatment,  and  any  remedy  that  would  have  a  tendency 
in  controlling  it,  ought  to  be  viewed  as  a  great  benefit 
to  the  public.  Cod  liver  oil  possesses  this  in  a  great 
degree,  use  it  as  an  external  application  three  or  four 
times  a  day,  to  the  throat  and  chest. 


184 


DENGUE. 


DENGUE. 

This  is  a  very  singular  affection,  and  one  that  seems 
to  be  peculiar  to  our  climate ;  fortunately,  however,  its 
history,  unlike  many  other  epidemics,  has  been  distin- 
guished, less  by  its  fatality  than  mere  suffering. 

"In"  the  annals  of  medicine,  there  is  not,  perhaps, 
recorded  a  disease  so  severe  in  its  accession  and  duration, 
and  so  seldom  leading  to  a  fatal  issue." 

Symptoms. — We  are  presented  in  the  onset  with 
those  peculiar  symptoms  that  usher  in  bilious  fever,  with 
this  difference,  that  the  febrile  symptoms  are  of  a  more 
inflammatory  character,  accompanied  with  great  pain 
in  the  limbs  and  muscles.  These  symptoms  continue 
for  two  or  three  days,  when  the  symptoms  of  aggrava- 
tion begin  to  subside,  and  with  them  the  excruciating 
pain.  From  the  second  to  the  third  day  it  is  accompa- 
nied with  nausea,  and  generally  great  irritability  of  the 
stomach.  We  have  seen  a  rash  or  eruption  accompany- 
ing it,  which,  in  my  opinion,  is  only  an  incidental 
symptom;  but  my  friend,  Dr.  McCraven,  for  whose 
professional  opinion  I  have  a  high  regard,  is  of  the 
opinion  that  this  rash  or  eruption  is  one  of  the  symptoms 
that  most  generally  presents  itself. 

The  eruption,  when  it  does  appear,  is  generally  from 
the  fourth  to  sixth  day,  it  resembles  scarlatina  more 
than  measles,  it  consists  of  florid  red  papula),  very 
minute,  slightly  elevated,  and  not  so  confluent  as  in 
measles  or  scarlatina. 

It  has  been  classed  amongst  the  exanthemata,  but  in 
my  opinion  it  certainly  partakes  more  of  the  nature  of 
both  eruptive  and  arthritic  fevers,  than  of  the  former. 
Dr.  Waring,  of  Savannah,  considers  it  to  have  been 
closely  analogous  to  the  "break-bone"  fever,  and  in  our 


DEXGUE.  185 

humble  opinion  it  is  one  and  the  same  thing  under  a 
different  name  only,  and  the  analogy  is  so  closely  iden- 
tified that  it  would  indeed  be  difficult  for  me  to  draw 
the  distinction  between  the  two,  if  any  peculiarity  really 
exists. 

A  distinguished  author  says,  and  says  truly,  that  it 
is  for  the  most  part  a  difficult  task  to  point  out  the  pre- 
cise origin  of  any  form  of  disease,  and  with  respect  to 
what  are  called  vaguely,  general  epidemics,  the  attempt 
has  been  notoriously  futile.  Local  epidemics,  however, 
among  which  dengue  must  of  course  be  ranked,  if  its 
contagious  nature  be  denied,  are  always,  as  pneumonia 
typhoides,  for  example,  limited  to  particular  season  and 
temperature;  or,  as  in  the  case  of  bilious  remittent, 
dysentery,  and  yellow  fever,  to  certain  localities  and 
circumstances  of  soil  and  surface,  conjointly  with  season 
and  temperature.  But  dengue  has,  in  its  brief  career 
and  well  known .  history,  shown  no  correspondence  with 
any  of  these,  being  neither  limited  by  season,  local 
position,  nor  atmospheric  change.  Its  gradual  progres- 
sion from  one  place  to  another,  allowing  abundant  room 
for  the  anticipation  of  its  arrival,  and  the  fact  that  "  it 
followed,"  from  the  time  when  it  first  appeared  upon  the 
American  coast,  "  the  great  routes  of  commercial  inter- 
course," are  strong  evidences  in  favor  of  its  contagious- 
ness. But  there  are  positive  and  marked  facts  which 
seem  to  us  leave  no  room  for  reasonable  doubt  on  the 
subject. 

Dr.  Stedman  traces  the  communication  of  dengue 
clearly  from  St.  Thomas  to  St.  Croix.  Christianstoedt, 
which  is  the  seat  of  government  of  the  latter,  and  on 
this  account,  and  from  its  proximity  to  the  former  island, 
enjoys  a  freer  intercourse  with  it,  was  invaded  a  week 


186 


DENGUE. 


or  two  before  the  town  in  which  he  resided,  Frederick- 
stcedt.  The  first  patient  whom  he  saw  had  arrived 
three  days  before  from  St.  Thomas,  and  the  disease 
appeared  first  in  the  family  with  whom  this  patient  had 
come  to  reside ;  among  them,  indeed,  it  raged  exclusively 
for  some  time,  with  the  exception  of  a  family  residing 
opposite,  the  head  of  which  had  frequent  mercantile 
business  with  Christianstoedt.  From  there  it  extended 
through  the  town.  "  The  disease,"  he  says,  explicitly, 
"  spread  from  family  to  family,  and  from  estate  to  estate 
exactly  in  proportion  to  their  contiguity,  or  to  the  inter- 
course that  might  happen  to  exist;"  and  gives  an 
instance  of  the  latter  kind,  when,  from  the  communi- 
cation between  two  estates  belonging  to  the  same  master, 
the  one  near  town  and  the  other  four  or  five  miles 
distant,  the  negroes  on  the  latter  estate  "  got  the  disease 
at  a  time  when  it  had  not  spread  to  any  other  in  that 
neighborhood." 

In  the  City  of  Charleston,  the  earliest  cases  happened 
in  persons  connected  with  vessels  that  had  arrived  from 
the  Island  of  Cuba,  where  dengue  then  prevailed.  This 
fact  is  clearly  made  out  upon  the  authority  of  two  phy- 
sicians of  the  highest  respectability.  Professor  T.  Prio- 
leau  attended  the  first  patient,  a  negro,  who  was  put  on 
board  the  brig  Emmeline,  just  in  port,  whose  captain 
had  been  ill  with  dengue  a  few  days  before  he  left  Ha- 
vana. The  next  persons  attacked  were  the  ship-car- 
penter and  his  family,  who  went  on  board  to  effect  some 
repairs  in  the  same  vessel.  From  these  the  disease 
spread  as  from  a  centre.  A  short  time  after  these  events 
occurred,  Dr.  P.  G.  Prioleau  was  called  to  attend  the 
family  of  the  captain  of  another  vessel  who  had  arrived 
here  about  the  same  period,  laboring  under  the  disease. 


DENGUE. 


187 


The  dates  in  these  instances  are  worth  recording.  Cap- 
tain W.  arrived  in  Charleston  on  the  31st  of  May,  ill 
of  dengue :  on  the  20th  of  June,  his  wife  was  seized ; 
on  the  1st  of  July,  two  of  his  daughters ;  on  the  2d,  his 
son;  "it  soon  extended  to  the  rest  of  the  family." 
Prof.  Prioleau's  first  case,  the  negro  above  mentioned, 
was  taken  ill  on  the  10th  of  June;  his  second  case  on 
the  23d.  Here  we  have  two  central  spots  whence  the 
dengue  rapidly  diffused  itself  throughout  the  city. 
These  early  patients  were  far  from  being  in  the  same 
neighborhood.  The  brig  Emmeline  lay  at  Knox  and 
Pritchard's  wharf,  in  the  upper  part  of  the  town.  Cap- 
tain W.  resided  in  Tradd  street,  nearly  or  quite  a  mile 
distant. 

Farther  circumstances  of  a  similar  nature  deserve 
notice,  as  tending  to  throw  some  light  on  the  nature  and 
history  of  this  strange  affection.  It  made  its  appearance 
at  two  points  in  the  vicinity  of  the  city,  the  qualities  of 
the  soil  and  atmosphere  of  which  were  as  strongly  con- 
trasted as  possible.  One  of  them,  Haddrill's  point,  is  an 
elevated  sandy  bluff,  about  four  miles  from  Charleston, 
across  the  bay,  noted  for  the  salubrity  of  its  air,  and  the 
health  of  its  inhabitants.  It  has  never  been  invaded  by 
the  yellow  fever,  even  in  the  most  pestilential  seasons 
of  its  epidemic  prevalence.  Yet  some  cases  of  dengue 
occurred  there,  introduced,  as  he  himself  had  stated,  by 
a  clergyman  whose  family  resided  at  Haddrill's,  while 
he  attended  to  his  official  duties  in  the  city,  and  by  "  a 
neighbor  similarly  situated."  The  second  instance  was 
that  of  a  plantation  lying  about  four  miles  from  Charles- 
ton, in  the  opposite  direction,  in  a  low  malaria  country, 
the  residents  upon  which  were  annually  subject  to 
ordinary  remittent  fevers.    The  head  of  the  family  and 


188 


DENGUE. 


a  negro,  having  visited  the  city,  were  both  taken  ill  in 
about  a  week  afterwards ;  the  wife  of  the  former  was 
next  seized,  and  the  disease  afterwards  extended  among 
both  the  whites  and  the  negroes  in  that  place. 

Prognosis. — The  prognosis  in  this  singular  affection 
was  remarkably  favorable.    Perhaps  no  form  of  disease 
is  known  in  which  the  proportion  of  deaths  is  so  small, 
compared  with  the  numbers  attacked.    Influenza  alone 
spreads  with  a  universality  of  invasion  at  all  resembling 
it,  and  even  influenza  is  inferior  in  the  infrequency  of 
exceptions  to  its  attack.    "In  a  population  of  about 
12,000  souls  who  occupy  the  town  of  St.  Thomas,"  says 
Stedman,  "scarcely  a  single  individual  escaped."  In 
all  its  seats  few  died;  whether  managed  by  the  best 
professional  skill  or  mere  domestic  attention,  or  totally 
neglected.    Yet  there  was  a  vast  difference  in  the  de- 
grees of  the  suffering  undergone  by  different  patients, 
and  not  a  little  in  the  duration  of  the  suffering  and  in 
the  rapidity  and  perfectness  of  their  convalescence. 
The  aged  were  most  severely  handled,  remaining  fre- 
quently infirm  and  debilitated,  with  languor  and  emaci- 
ation.   Corpulent  persons  usually  suffered  much,  and 
recovered  very  slowly.    The  intemperate  paid  in  this, 
as  in  every  other  form  of  disease,  a  heavy  tax  for  their 
degrading  indulgences.    In  many  it  served  to  usher  in 
formidable  paroxysms  of  delirium  tremens.  Dengue, 
indeed,  can  hardly  be  said  to  have  ever  proved  fatal  of 
itself.    The  rare  instances  in  which  patients  died,  while 
laboring  under  it,  presented  some  complication  under 
whose  incidental  symptoms  the  patient  sank ;  or  some 
extreme  feebleness  of  constitution  in  which  the  remedies 
employed  were  productive  of  fatal  effects.    More  than 
one  example  of  this  nature  is  placed  on  record." 


DENGUE. 


189 


Treatment. — The  lancet  is  highly  recommended  by 
Southern  authors.  For  myself,  I  confess  I  have  never 
seen,  in  my  opinion,  any  necessity  for  its  use;  and  I 
am  satisfied  we  have  it,  with  as  high  inflammatory 
fever,  and  with  as  much  virulence,  as  it  is  found  at  any 
other  point.  My  friends,  If  Craven,  Ewing  and  Parker,  I 
am  sure,  like  myself,  deprecate  the  use  of  the  lancet. 

My  treatment  is  very  simple,  hut  such  as  I  am  sure 

will  relieve  the  patient  as  readily  as  any  other  mode. 

I  use  local  applications  of  warm  water  to  the  head  and 

chest,  give  large  doses  of  Dover's  powders  every  half 

hour,  in  combination  with  sage  or  horsemint  tea,  until 

free  perspiration  is  produced.    After  which,  I  generally 

administer  the  following : — 

o  • 

Podophyllum  grs.  ii. 

Sul.  Quinine,  3i. 

Divide  into  8  powders,  give  one  every  two  hours,  in 
a  half  tea-spoonful  of  castor  oil,  until  free  hypercathar- 
sis  (purging)  is  produced.  If  there  is  nausea,  apply  a 
mustard  plaster,  over  the  epigastric  region,  (stomach.) 
or  administer  a  drop  of  kreosote  in  milk.  After  the 
free  operations  of  the  medicine,  give  Dover's  powders 
and  quinine  in  combination,  and  you  will  soon  have  the 
pleasure  of  seeing  your  patient  convalescent. 

Many  Southern  physicians  of  high  repute,  speak  of 
opium  "as  the  Sampson  in  this  disease,  and  I  confess  I 
have  used  it  with  more  success  in  allaying  the  excru- 
ciating pain  of  which  patients  complain,  than  with 
any  other  remedy.  Doctors  Rush  and  Dickson  highly 
commend  it  to  the  profession,  the  former  says  "its  salu- 
tary effects  in  procuring  sweat  and  a  remission  of  the 
fever,  led  me  to  prescribe  it  in  almost  every  case,  and 


190 


RHEUMATISM. 


always  with  the  happiest  effects."  In  a  more  extended 
experience,  Dr.  Dickson  says  "  that  this  benevolent  man 
would  have  been  delighted  to  find  that  it  was  entirely 
unnecessary,  at  least  in  a  large  majority  of  the  cases, 
to  w^ait  for  what  he  styles  the  "  proper  evacuation,"  but 
that  this  relief,  or  diminution  of  pain  and  anguish,  might 
safely  be  accorded  to  the  patient  at  the  very  commence- 
ment of  the  attack."  I  cannot  refrain  from  quoting  the 
paragraph  from  him  in  regard  to  this  article,  he  says 
".the  profession  has  much  to  learn  upon  the  subject  of 
the  admissibility  of  opium  in  the  treatment  of  fevers 
generally,  and  declaring,  as  I  do,  with  entire  sincerity, 
that  the  most  agreeable  and  satisfactory  of  all  my  expe- 
rience in  the  healing  art,  has  consisted  in  the  employ- 
ment of  this  divine  remedy  in  states  of  the  system,  and 
under  circumstances  which  dogmatists  of  all  sects  have 
taught  to  offer  positive  contra-indications  to  its  exhibi- 
tion." 


ARTHRITIC  FEVERS. 

RHEUMATISM. 

This  disease  has  frequently  a  resemblance  to  gout, 
and  approximates  so  nearly,  that  it  is  with  difficulty 
that  it  is  distinguished.  It  makes  its  attacks  in  all 
seasons  of  the  year,  when  the  atmosphere  is  moist  and 
variable,  but  is  more  frequently  met  with  in  autumn 
and  spring.  It  is  sometimes  accompanied  with  fever, 
and  when  it  is,  it  is  styled  acute  rheumatism;  if  no 
fever,  it  is  styled  chronic  rheumatism. 

Symptoins. — They  are  so  well  known,  it  would  be 
folly  to  enter  into  a  minute  detail  of  them.    The  acute 


RHEUMATISM. 


191 


form  commonly  begins  -with  weariness,  shivering  or 
quick  pulse,  restlessness,  thirst,  and  other  symptoms  of 
fever. 

The  chronic  form  is  seldom  attended  with  any  con- 
siderable degree  of  fever,  and  most  generally  confined 
to  some  particular  part  of  the  body,  generally  the 
shoulder,  back  or  loins.  There  is  seldom  any  inflam- 
mation or  swelling  in  this  variety. 

Treatment. — Mild  purges,  large  doses  of  nitre,  and  the 
cold  dash,  I  have  used  with  the  happiest  effects.  I 
have  seen  some  few  cases,  that  required  the  lancet,  but 
I  have  substituted  in  its  stead  the  alcoholic  bath,  which 
I  have  tested  in  the  severest  cases  of  inflammatory 
rheumatism,  in  almost  every  stage,  and  it  has  always 
met  my  most  sanguine  expectations.  The  patient  will 
get  relief  in  a  short  period,  and  it  should  be  repeated 
twice  a-day,  for  three  or  four  days.  If  this  remedy  is 
resorted  to,  it  should  be  followed  by  Dover's  powders, 
which  is  a  valuable  remedy  at  almost  any  stage  of  the 
disease;  it  should  be  persevered  in  until  perspiration 
is  induced,  and  its  effects  should  be  kept  up,  by 
drinking  freely  of  an  infusion  of  catnip.  If  the  pain 
prevents  sleep,  the  following  recipe  we  have  used  both 
as  an  anodyne  and  diaphoretic. 

ty.    Powdered  aconite  leaves. 

Precip.  sulph.  of  antimon.,  each  one  grain. 
Carbonate  of  magnesia,  9i. 

Mix  and  give. 

Where  there  is  swelling  and  violent  pains  of  the 
joints,  a  poultice  of  "  bran  and  vinegar  can  be  simmered 
to  the  proper  consistence,"  and  applied.  I  have  fre- 
quently used  beneficially,  hops  steeped  in  warm  vine- 


192 


RHEUMATISM. 


gar,  though  a  far  better  article,  and  one  of  greater 
efficacy,  will  be  found  in  a  combination  of  lobelia  and 
eupatorium,  (thorough wort,  boneset,)  as  a  fomentation. 

We  have  tried,  in  the  inflammatory  stage,  Town- 
sends  Sarsaparilla, — to  a  quart  bottle  we  have  added 
two  scruples  of  the  hydrate  of  potash,  and  give  a  table- 
spoonful  three  or  four  times  a-day  with  decided  benefit. 

Dr.  Aldis,  of  London,  is  a  strong  advocate  of  the 
lancet,  and  a  favorite  prescription  with  him,  which  he 
gives  after  venesection,  is 

^.    Colchicum  wine,  gtts.  xii. 

Sulphate  magnesia,  5i. 

Camphor  mixture,  flsl. 
every  six  hours. 

Also, 

Opium,  grs.  ss. 

Chloride  of  mercury,  grs.  ii. 

This  pill  is  repeated  every  night  for  two  or  three  nights, 
as  well  as  the  former  recipe,  which  is  taken  through 
the  day.  In  regard  to  this  practice,  we  will  let  the 
Doctor  speak  for  himself : — "  I  learnt  this  mode  of 
treating  rheumatism  at  St.  George's  Hospital,  under 
Dr.  Chambers,  whose  practice  it  was  to  bleed,  purge, 
and  administer  calomel  and  opium;  and  I  have  em- 
ployed it  during  twenty-four  years,  in  a  large  dispen- 
sary practice,  with  the  most  signal  advantage." 

He  says  he  has  found  a  modification  of  the  above 
treatment,  viz :  calomel  and  opium,  and  colchicum,  with 
saline  aperients — most  serviceable  in  the  treatment  of 
gout 


RHEUMATISM. 


193 


Arnica. — The  extract  taken  internally,  and  a  foment- 
ation applied  externally,  is  recommended  very  highly; 
I  have  never  tried  it. 

Ipecacuanha,  given  in  grain  doses  every  hour,  (if  the 
stomach  will  bear  it,)  will  prove  serviceable  as  a  purga- 
tive in  this  disease. 

The  diet  should  be  light,  and  in  small  quantity,  such 
as  roasted  apples  and  gruel. 

Chronic  EJieumatism. — Treatment. — You  must  try  and 
ascertain  the  remote  cause,  as  it  may  have  been  so 
slight  as  to  have  been  entirely  overlooked.  You  are  to 
distinguish,  clearly  between  local  and  general  rheuma- 
tism, from  the  fact  that  local  affections,  such  as  white 
swelling,  are  frequently  confounded  with  chronic  rheu- 
matism, especially  when  the  knee  is  the  part  affected. 
The  treatment  for  this  form  of  the  disease,  must  be 
both  local  and  constitutional. 

Bandaging  the  effected  limb  somewhat  tightly  with 
flannel  rollers,  continuing  it  above  the  affected  joint, 
will  prove  serviceable.  Some  of  the  eastern  physicians 
speak  in  high  terms  of  the  sabin,  (juniperus  sabina,) 
and  contend  that  it  is  entitled  to  be  placed  at  the  head 
of  remedies,  for  this  truly  distressing  disease ;  Dr. 
Chapman  gives  from  twelve  to  fifteen  grains  of  the 
powdered  leaves  three  times  a  day,  gradually  increasing 
the  dose  ;  it  should  be  persevered  in,  the  want  of  per- 
severance generally,  is  one  of  the  main  causes  why 
chronic  diseases  are  so  seldom  relieved. 

La  this  form,  I  have  used  evacuants,  an  emetic 
followed  by  a  cathartic,  at  least  once  a  week,  the  bowels 
should  be  kept  freely  open  in  the  meantime,  by  aperi- 
ents, for  this  purpose  I  use  the  following  : 

13 


194 


RHEUMATISM. 


Podophylline,  (Mandrake.) 
Sanguinaria,  (Blood-root.) 
Iris,  (Germanica.) 
Hydrastis,  (Tumeric  root.) 

Apocynun,  (eq'l.  parts,)  (Dogs-bane, 

(Indian  hemp.) 
Dose,  as  an  alterative,  about  ten  grains  at  night. 
Continue  with  this  an  equal  amount  of  alkaline  or  com- 
pound powder  of  rhubarb,  which  is  as  follows  : — 

Rhubarb. 
Saleratus. 

Spearmint  leaves,  equal  parts. 
This  in  combination,  can  be  given  in  15  grain  doses, 
twice  a  day,  or  just  enough  to  move  the  bowels  two  or 
three  times. 

Before  each  meal,  the  patient  should  take  in  cold 
water,  from  one  to  two  drachms  of  the  following  recipe  : 

ty.  Pulv.  gum  guiacum,  Siv. 
Allspice,  Siv. 
Saleratus,  S.vi. 
Alcohol,  2  quarts. 

Digest  and  filter. 

Add  tinctures  of  macrotys,  black  snake  root,  and 
Xanthoxylum,  equal  parts.  . 

Dose. — Table-spoonful  three  times  a  day. 

In  the  chronic  form,  I  have  great  confidence  in  the 
alcoholic  vapor  bath,  use  it  twice  a  week,  just  before  re- 
tiring to  rest,  in  connection  with  this.  As  a  local  appli- 
cation to  the  affected  joints,  I  use  a  rheumatic  liniment 
composed  of  the  oils  of  cedar,  cloves  and  sassafras,  and 
very  frequently,  a  liniment  called  in  the  apothecary 


RHEUMATISM. 


195 


shops  here,  "  Massie's  liniment,"  which  I  have  found 
beneficial,  and  safely  assert  that  you  will  find  it  superior 
to  the  world-renowned  Mustang,  wherever  that  is  neces- 
sary to  be  used,  the  recipe  will  be  given  in  the  volume. 

A  thorough  examination  should  be  made  of  the  spine, 
and  upon  pressure  you  will  be  apt  to  find  tenderness, 
whenever  such  is  found  apply  the  following  plaster, 
which  can  be  used  also  when  the  pain  is  confined  to 
large  joints : 

R.    Sang.  Can.,  (Blood  root.) 

Pod.  Pel.  (Mandrake.) 
Arum  Triphyllum,       (Indian  Turnip.) 
Phytollacca  decandria,  (Poke  root.) 

of  each,  pulverized  gill. 
Tar,  1  quart. 

Rosin,  4  oz. 

Boil  the  tar  until  its  water  is  evaporated,  add  the 
rosin,  and  let  it  melt ;  and  add  the  powders  while  it  is 
hot,  stir  briskly  until  it  becomes  stiff.  As  a  slow 
counter-irritation  and  revulsion,  it  has  no  equal. 

This  preparation  should  be  spread  quite  thin  at  first, 
and  on  soft  leather;  it  should  be  removed  daily,  and 
spread  more  plaster  on  the  same  leather. 

The  phytollacca  decandria,  or  pokeroot,  one  of  the 
preparations  of  the  plaster,  as  an  indigenous  remedy, 
enjoys  considerable  reputation.  You  take  the  expressed 
juice,  and  mix  with  a  small  portion  of  brandy,  to  keep 
it  from  fermenting,  and  of  this  a  small  wine-glassful 
can  be  taken  two  or  three  times  a  day. 

I  have  considerable  confidence  in  the  sarsaparilla  and 
hydriodate  of  potash,  the  same  as  recommended  in  the 
acute  form. 


196 


RHEUMATISM. 


Fowler's  solution  of  arsenic  possesses  strong  anti-rheu- 
matic qualities.  From  six  to  ten  drops  may  be  taken 
three  or  four  times  a  day.  The  administration  of  bal- 
sam copaibae  is  entitled  to  consideration  in  this  form,  of 
the  disease.  » 

Cold  bathing,  especially  in  salt  water,  has  often  cured 
chronic  rheumatism.  I  have  used  a  domestic  remedy 
of  garlic,  put  into  good  Holland  gin,  with  decided  advan- 
tage. 

Such  as  are  subject  to  frequent  attacks  of  the  rheu- 
matism ought  to  make  choice  of  a  dry,  warm  situation, 
to  avoid  the  night  air,  wet  clothes  and  wet  feet  as  much 
as  possible.  Their  clothing  should  be  warm,  and  they 
should  wear  flannel  next  their  skin,  and  make  frequent 
use  of  the  flesh  brush. 

We  append  some  remedies,  not  specified  in  our  treat- 
ment, that  we  have  used  with  advantage  in  the  chronic 
form  of  this  formidable  disease. , 

^.    Powdered  resin  of  guaiacum,  5ii. 

"      gum  arabic,  3iii.  - 

Extract  bitter  sweet,  3iii, 
Syrup  of  Mallows,  flgi. 
Distilled  water,  flSvii. 
Mix.    A  table-spoonful  every  three  or  four  hours. 

The  oil  of  Guaiacum  wood  is  a  good  external  applica- 
tion. 

3$j.  Rasped  guaiacum  wood,  two  drachms;  water 
sufficient  to  obtain  one  pint  of  strained  decoction.  After 
an  hour's  boiling,  add,  wine  of  colchicum  seed,  5ii. 

Dose.    A  wine-glassful  every  two  hours. 


RHEUMATISM. 


197 


Powdered  resin  of  guaiacum. 

Golden  sulphuret  of  antimony,  aa.  3ss. 

Calomel,  x.  grs. 

Ex.  Dandelion,  q.  s. 

M.  ft.    Divide  into  3  gr.  pills. 
Dose.    Three,  three  times  a  day. 

In  sciatica,  and  other  chronic  forms,  I  have  frequently 
used,  with  great  advantage, — 

Hydriodate  potash,  grs.  xxiv. 
Hop  tea,  1  pint. 

Make  a  solution,  and  give  one-third  morning,  noon  and 
night. 

The  following  ointment  is  a  valuable  application  : 

Veratrin,  5ss. 
Powdered  opium,  5i. 
Lard,  Siss. 
Mix.    Kub  it  on  well. 

We  have  spoken  of  the  alcoholic  sweat,  and  to  show 
the  efficacy  of  this  little  appreciated  measure,  (the  alco- 
holic sweat,)  I  will  state,  that  in  the  severest  cases  of 
inflammatory  rheumatism,  in  the  early  as  well  as  the 
later  stages,  I  have  never  known  it  fail  to  relieve. 

An  application  termed  firing,  has  obtained  much 
celebrity,  and  we  have  extracted,  from  Drs.  King  and 
Newton's  late  work,  the  mode  of  its  precise  application. 
"  Obtain  a  thick  iron  wire  shank,  about  two  inches  long, 
and  inserted  into  a  small  wooden  handle;  on  its  ex- 
tremity, which  must  be  slightly  curved,  have  a  disc  or 
button  of  iron,  exactly  one-quarter  of  an  inch  thick, 
and  half  an  inch  in  diameter.    The  whole  instrument 


198 


RHEUMATISM. 


to  be  only  six  inches  in  length.  The  face  of  the  disc 
for  application  must  be  flat. 

Mode  of  Application. — Light  a  small  spirit  lamp,  and 
hold  the  button  over  the  flame,  keeping  the  forefinger 
of  the  hand  holding  the  instrument,  at  the  distance  of 
about  half  an  inch  from  the  button.  As  soon  as  the 
finger  feels  uncomfortably  hot,  the  instrument  is  ready 
for  use,  and  the  time  required  for  heating  it  to  this 
degree,  will  be  about  half  a  minute.  It  is  to  be  applied 
as  quickly  as  possible  to  the  parts,  the  skin  being  tipped 
successively,  at  intervals  of  half  an  inch  over  the  affected 
part,  as  lightly  and  as  rapidly  as  possible,  always  taking 
care  to  bring  the  flat  surface  of  the  disc  fairly  in  con- 
tact with  the  skin.  In  this  way  the  process  of  firing 
a  whole  limb,  or  the  loins,  making  about  one  hundred 
applications,  does  not  occupy  a  minute,  and  the  one 
heating  by  the  lamp  suffices.  To  ascertain  whether 
the  heat  be  sufficient,  look  sidewise  at  the  spots  as  you 
touch  them,  and  each  spot  will  be  observed  to  become 
of  a  glistening  white,  much  whiter  than  the  surround- 
ing skin.  In  from  five  to  thirty  minutes  the  skin  be- 
comes bright  red,  and  a  glow  of  heat  is  felt. over  the 
part.  The  iron  must  never  be.  made  red  hot — it  is 
very  little  hotter  than  boiling  water — should  never 
make  an  eschar,  and  rarely  raise  a  blister.  On  the 
next  day  after  its  application,  a  number  of  circular  red 
marks  will  be  seen  on  the  skin,  the  cuticle  not  even 
being  raised,  and  the  surface  ready,  if  necessary,  for  a 
fresh  application.  There  is  no  discharge  whatever,  and 
in  most  cases  the  patient  is  unconscious  of  what  has 
been  done.  It  is  vastly  superior  to  a  blister  in  many 
cases ;  even  the  most  delicate  female  will  not  object  to 
its  frequent  repetition  when  required. 


RHEUMATISM.  199 

Properties  and  Uses.  —  A  powerful  counter-irritant. 
Eecommended  by  Dr.  Corrigan  in  paralysis,  local  mus- 
cular rheumatism,  sciatic,  lumbago,  neuralgic  pains,  &c, 
and  wherever  a  counter-irritant  is  required.  Also  ap- 
plied each  side  of  the  spinal  column,  in  intermittents, 
epilepsy,  mania  and  other  diseases." 

The^  Macrotys  Eacemora  (Black  Cohosh,)  is  an  article 
of  great  value  in  this  disease,  and  should  be  investi- 
gated by  all.  The  saturated  tincture  of  this  article  is 
the  form  in  which  I  like  it  best ;  it  should  be  given  in 
doses  of  ten  drops  every  two  hours,  gradually  increas- 
ing to  sixty  drops ;  its  action  must  be  kept  up  for 
several  days. 

We  annex  a  very  valuable  rheumatic  tincture,  and 
one  that  will  be  found  exceedingly  efficacious  as  an 
external  application,  in  almost  every  painful  affection. 

^.    Camphor,  one  pound, 
il  of  Origanum. 

Hemlock,  aa.  half  pound. 
"  Sassafras. 
"    Cajeput,  aa.  Bii. 
"    Turpentine,  Sii. 
Capsicum,  5rv. 
Alcohol,  1  gallon. 

Macerate  for  fourteen  days  and  filter.  In  ordinary 
cases,  apply  two  to  four  tea-spoonfuls  to  the  affected 
part,  and  rub  it  well  by  the  fire,  and  afterwards  moisten 
flannel  with  it  and  apply  to  the  diseased  part. 

Lemon  juice  is  now  much  used  in  rheumatism,  the 
practice  is  to  use  it  freely. 

The  following  recipe  for  rheumatic  inflammation  has 
been  lately  presented  to  the  French  Academy  of  Sci- 


Oi, 


200 


GOUT. 


ences,  by  a  retired  army  surgeon  of  Paris,  as  possess- 
ing extraordinary  curative  properties  in  the  above  pain- 
ful affection. 

Dr.  Poggioli,  the  discoverer,  states  that  in  seventeen 
cases  of  rheumatism,  the  complaint  yielded  immediately 
on  the  application  of  this  new  remedy. 

Recipe. — A  salt  of  morphia  (hydrachloratis,)  distilled 
water,  extract  of  belladonna  (atzopine,)  ointment,  made 
of  the  buds  of  the  poplar  tree,  leaves  of  black  poppy, 
belladonna,  hen-bane  and  nightshade ;  animal  fat,  mac- 
erated in  datura  leaves,  q.  s.  The  composition  to  be 
scented  with  essence  of  lemon  or  cherry  laurel  water. 
In  many  instances  mentioned  by  the  discoverer,  one 
rubbing  was  sufficient,  *with  the  application  of  linseed 
poultices  afterwards,  to  effect  a  perfect  cure;  it  may, 
however,  be  sometimes  expedient  to  apply  it  for  a  week 
at  the  utmost.  The  proportional  quantities  of  pre- 
scription must  be  regulated  according  to  the  constitu- 
tion of  the  patient,  as  well  as  the  nature  and  extent  of 
the  malady.  The  inventor,  in  his  account  to  the  aca- 
demy, states  it  to  be  the  result  of  several  years  labor 
and  experience. 

GOUT. 

Gout  is  a  disease  resembling,  in  many  particulars, 
rheumatism;  and  there  is  no  disease  which  shows  the 
imperfection  of  medicine  more,  and  yet  none  that  teaches 
the  advantages  of  temperance  and  exercise  in  a  greater 
light,  than  the  gout. 

Indolence  and  intemperance,  in  a  large  number  of 
cases,  are  evidently  the  principal  causes  of  this  disease ; 
yet  there  are  other  things  which  greatly  contribute,  in 
many  instances,  to  induce  a  paroxysm;  for  instance, 


GOUT. 


201 


intense  study,  excess  of  venery,  too  free  use  of  acidulated 
liquors,  night  watching,  grief  and  uneasiness  of  mind, 
an  obstruction  or  defect  of  any  of  the  customary  dis- 
charges. 

Sytwptotns. — This  most  excruciating  painful  disease  is 
generally  preceded  by  eructations,  sickness  and  head- 
ache ;  the  patient  complains  of  weariness  and  dejection 
of  spirits,  the  appetite  generally  keen  a  day  or  two 
before  the  attack,  a  slight  pain  in  passing  mine,  (and 
there  is  one  remarkable  feature  in  g6ut,  you  will  in 
almost  all  cases  find  it  accompanied  with  stone  of  the 
bladder.) 

It  is  almost  certain  to  make  its  attack  in  the  night, 
and  in  a  majority  of  cases  the  great  toe  is  the  member 
seized.  I  have  seen  the  parts  attacked  become  so  exqui- 
sitely sensitive  that  the  patient  could  not  bear  to  have  it 
touched;  the  least  jar  in  the  room  would  affect  them 
materially.  It  seems  to  confine  itself  mostly  to  the 
male  sex.    I  have  never  seen  a  female  patient. 

Causes. — This  is  one  of  the  great  hereditary  affections. 
It  most  frequently  attacks  in  January  or  February,  but 
there  is  no  universal  rule. 

Where  it  is  not  hereditary,  the  exciting  cause  without 
doubt  consists  in  too  free  an  indulgence  in  nutritious 
foods,  too  great  an  excess  in  wine,  with  insufficient 
exercise. 

It  generally  occurs  in  stout,  robust  and  short  persons, 
and  those  of  a  sanguineous  temperament  ;  but  I  have 
seen  it  in  persons  extremely  spare. 

It  never  has  been  known  in  eunichs;  at  least,  so  it  is 
said.  If»such  be  the  case,  gouty  old  gentlemen  have  an 
easy  remedy. 


202 


GOUT. 


Treatment. — We  open  our  treatment  with  a  paragraph 
from  Dr.  Watson,  which  is  to  the  point  and  true. 

"  In  the  interval  between  attacks  of  gout,  whether  re- 
gular or  irregular,  it  must  be  chiefly  regimenal.  The  in- 
stances are  not  few  of  men  of  good  sense,  and  masters  of 
themselves,  who,  being  warned  by  one  visitation  of  the 
gout,  have  thenceforth  resolutely  abstained  from  rich 
living,  and  from  wine  and  strong  drinks  of  all  kinds,  and 
who  have  been  rewarded  for  their  prudence  and  self- 
denial  by  complete  immunity  from  any  return  of  the 
disease;  or  upon  whom,  at  any  rate,  its  future  assaults 
have  been  few  and  feeble." 

Cold  water  applications  have  been  recommended;  but 
I  view  it  as  an  extremely  dangerous  remedy  in  this 
disease.  It  has  a  tendency  to  produce  metastasis,  (a 
sudden  change  from  one  place  to  another) ;  apoplexy 
has  been  induced  by  it ;  serious  affections  of  the  heart, 
and  sudden  death,  have  resulted  from  it.  We  dwell  on 
this  application  from  the  fact  that  patients  are  generally 
inclined  to  use  it,  and  it  is  due  from  their  medical  advi- 
sers to  guard  them  against  it. 

The  chief  indications  to  be  fulfilled  in  this  painful 
disease,  is  to  regulate  the  diet,  let  that  be  of  a  mild 
farinaceous  character,  perfect  quiet,  gentle  purges,  and 
in  my  opinion,  you  will  find  and  experience  as  much 
benefit  from  large  doses  of  opium  and  colchicum,  as  any 
other  remedy,  although  the  tincture  of  iodine  is  held  in 
high  repute  by  many. 

Wine-whey  is  a  good  article  of  drink  in  this  disease, 
as  it  promotes  perspiration  without  producing  arterial 
excitement,  I  generally  combine  a  tea-spo#onful  of 
spiritus  mindererus,  (acetate  of  ammonia,)  say  two  or 
three  times  a  day.    Any  local  application  upon  the 


GOUT. 


203 


afflicted  part  that  will  produce  insensible  perspiration, 
will  have  a  tendency  to  afford  great  relief,  and  for  this 
purpose,  I  know  of  nothing  equal  to  fur  or  wool.  The 
limb  should  be  completely  folded,  (if  I  may  use  the 
term,)  in  it. 

The  course  to  pursue  to  prevent  attacks  of  the 
gout,  is  to  observe  temperance,  and-  to  take  that  sort 
of  exercise  that  will  produce  free  perspiration.  Let 
milk  be  the  main  reliance  for  diet;  avoid  all  liquors, 
especially  sour  wines  and  champagne.  Sour  punch 
should  be  especially  avoided. 

I  am  inclined  to  the  opinion  that  the  irritating  plas- 
ter, as  recommended  in  rheumatism,  would  be  of  great* 
service  as  a  local  application.    I  have  never  tried  the 
local  application  of  chloroform,  but  think  it  would  afford 
relief. 

We  are  frank  in  acknowledging  that  the  profession 
has  not  discovered  as  yet  any  remedy  that  will  afford 
complete  relief  for  a  regular  paroxysm  of  the  gout.  The 
great  danger  is  in  metastasis,  (a  change  of  the  disease 
from  one  organ  to  another ;)  then  it  is  that  the  proper 
applications  are  absolutely  necessary. 

If  it  affects  the  head,  it  will  be  accompanied  with 
severe  head  ache,  drowsiness,  giddiness,  convulsions  and 
delirium ;  if  the  lungs,  great  oppression,  with  difficulty 
of  breathing ;  if  the  stomach,  extreme  sickness,  accom- 
panied with  violent  pain,  and  generally  a  total  loss  of 
strength. 

If  it  attacks  the  head  or  lungs,  every  effort  must  be 
resorted  to  to  invite  it  to  its  original  place.  Bathe  the 
feet  in  warm  water,  apply  cataplasms  to  the  soles,  the 
irritating  or  blistering  plaster  to  the  extremities,  and 
give  the  aromatic  preparation  of  rhubarb. 


204 


ERYSIPELAS. 


If  the  head,  opiates  and  stimulants  are  inadmissible. 
Your  reliance  will  be  upon  the  lancet,  active  cathartics, 
with  cold  applications  to  the  head,  with  the  same  appli- 
cations as  recommended  for  the  lungs  to  the  extrem- 
ities. 

If  it  attack  the  stomach,  ether  will  be  found  an  effica- 
cious remedy,  or  strong  wine  boiled  with  cinnamon  and 
drank  freely. 

The  prescription  of  aconite,  as  recommended  for 
rheumatism,  is  a  valuable  remedy  in  this  disease ;  and 
where  the  stomach  is  involved  the  following  recipe  will 
be  found  valuable. 

1^.    Powdered  ginger,       grs.  xv. 
Carbonate  of  amonia,  grs.  vi. 
Spirit  of  cinnamon,  5iss. 
Water,  fl.gi.  f> 

Mix  and  give. 


INFLAMMATION, 

ERYSIPELAS 

Is  an  acute  febrile  disease,  and  very  intense  in  its 
character;  it  is  always  attended  with  heat,  swelling, 
pain,  redness  of  the  skin  in  patches,  and  often  united 
with  vesication.  The  parts  are  much  swollen,  the  in- 
flammation very  intense,  the  pain  and  heat  very  great, 
and  the  constitution  frequently  much  disturbed.  Gene- 
rally the  redness  disappears  on  pressure,  and.  instantly 
returns  when  the  j)ressure  is  removed,  as  in  erythema 
and  roseola. 


ERYSIPELAS. 


205 


Symptoms. — It  is  ushered  in  with  a  shivering  sen- 
sation, pain  in  the  head  and  back,  heat,  thirst,  and  great 
restlessness,  and  a  rapid  pulse,  sometimes  vomiting  and 
delirium.  On  the  second,  third,  and  sometimes  on  the 
fourth  day,  the  parts  become  red,  and  swell,  small  pus- 
tules appear,  at  which  time  the  fever  generally  subsides. 

Sometimes  this  disease  is  primary,  and  at  athers  only 
a  symptom  of  some  other  malady.  There  is  no  portion 
of  the  body  but  what  is  liable  to  erysipelas,  but  it  most 
frequently  attacks  the  face  and  legs.  In  some  instances 
it  confines  itself  to  a  particular  locality,  and  in  others  it 
spreads  quickly  over  large  portions  of  the  surface ;  and, 
in  certain  comparatively  rare  cases,  does  not  cease  to 
make  progress  until  it  has  invaded  successively  every 
part  of  the  skin.  # 

The  face  ia.  very  liable  to  this  inflammation,  and  is 
often  so  much  swollen  that  every  feature  is  almost 
hidden.  The  eyes  are  closed,  the  Hps,  nose,  cheeks  and 
ears  greatly  enlarged,  the  nostrils  so  much  obstructed 
that  the  patient  cannot  breathe  through  them,  the 
mouth  so  stiff  that  he  speaks  with  difficulty,  and  the 
external  meatus  (opening  of  the  ear)  so  much  narrowed 
as  to  interfere  with  hearing.  The  disease  sometimes 
involves  the  whole  head,  and  extends  over  the  scalp ; 
when  such  is  the  case  it  is  much  swollen  and  pulpy,  and 
the  whole  head  becomes  enormously  enlarged.  In  this 
situation  the  parts  become  so  tender  that  pressure  pro- 
duces much  uneasiness. 

If  the  breast  is  the  seat  of  the  affection  it  becomes 
much  swollen,  and  very  hard,  producing  great  pain ;  in 
this  situation,  unless  active  remedies  are  resorted  to,  it 
is  apt  to  suppurate.  In  this  locality  it  is  always  accom- 
panied with  pain  under  the  armpit  of  the  affected  side. 


206 


ERYSIPELAS. 


When  the  erysipelas  is  large,  deep,  and  affects  a  very 
sensitive  part  of  the  body,  the  danger  is  great.  If  the 
red  color  changes  into  a  livid  or  black,  it  will  end  in  a 
mortification.  Sometimes  the  inflammation  cannot  be 
discussed,  but  comes  to  suppuration;  in  which  case 
gangrene  or  mortification  often  ensues. 

When  the  inflammation  and  fever  are  high,  they  are 
always  attended  with  great  difficulty  in  breathing. 

Treatment. — The  treatment  varies  according  to  the 
causes,  symptoms  and  complications  of  the  disease.  The 
mode  of  treatment  will  be  different  in  phlegmonous  or 
acute  erysipelas  from  what  it  would  be  in  the  other 
varieties,  which  must  be  apparent  to  any  one  who  makes 
the  least  pretensions  to  knowledge  of  diseases  in  general. 

The  common  acute  form  of  this  disease  generally 
yields  to  purgatives  and  diaphoretics,  enjoining  a  light 
vegetable  diet. 

"  After  the  inflammatory  symptoms  are  in  a  measure 
subdued"  ipecac,  will  exercise  a  powerful  influence  over 
the  disease. 

If  the  fever  be  high,  the  pulse  hard  and  strong,  and 
the  patient  vigorous,  it  will  be  proper  to  use  the  lancet, 
or  give  aconite  in  drop  doses,  to  control  the  arterial 
action.  In  our  opinion  it  is  not  so  necessary  to  bleed 
in  this  disease  as  is  so  frequently  done.  If  the  patient 
has  been  in  the  habit  of  using  ardent  spirits  to  excess, 
and  the  disease  has  attacked  his  head,  then  and  in  that 
case,  the  lancet  will  be  absolutely  necessary. 

In  cases  where  the  lancet  is  requisite,  it  is  necessary 
by  all  means  to  keep  the  bowels  in  a  free  soluble  con- 
dition, and  this  must  be  effected  by  those  remedies 
which  will  have  a  tendency  to  lessen  excitement.  I 
generally  administer  for  this  purpose  rhubarb,  in  com- 


ERYSIPELAS.  207 

bination  with  nitre.  If  the  mild  purgatives  I  have  here 
suggested,  fail  to  open  the  bowels  well,  stronger  (or 
drastic)  ones  must  be  resorted  to. 

If  the  disease  attacks  the  head,  you  must  apply  blis- 
ters to  the  neck,  behind  the  ears,  and  cataplasms  to  the 
extremities. 

Fine  wool  or  fur  are  good  applications,  they  exclude 
the  atmospherical  air  and  promote  perspiration,  which 
has  a  tendency  to  relieve  the  vessels  of  their  engorge- 
ment. 

When  the  inflammation  cannot  be  discussed,  and  the 
part  has  a  tendency  to  ulcerate,  it  will  then  be  proper 
to  promote  suppuration,  which  may  be  done  by  the 
application  of  ripening  poultices,  with  saffron,  flaxseed, 
slippery  elm,  warm  fomentations,  &c. 

When  the  skin  is  dry,  hot,  and  accompanied  with 
severe  inflammation,  the  most  soothing  application  is 
milk-warm  water,  but  neither  cold  or  warm  water  ought 
to  be  used,  unless  the  parts  are  in  the  precise  condition 
as  stated  here. 

A  large  number  of  the  English,  and  some  of  our  most 
enlightened  American  physicians,  recommend  free  inci- 
sions through  the  inflamed  surface,  and  across  its  whole 
extent.  I  have  tried  this  method  with  considerable 
success. 

In  some  cases  I  have  resorted  to  the  caustic  potash, 
giving  a  slight  touch  to  each  vesicle,  which  readily  pro- 
duces disorganization  of  the  morbid  structure,  and  if 
followed  with  an  emolient  poultice,  the  destroyed  parts 
readily  slough  off, — this  application  is  alone  proper  in 
cases  where  mortification  is  threatened. 

In  erysipelas  of  any  form,  I  am  a  great  advocate  of 


208 


ERYSIPELAS. 


quinine,  unless  there  should  be  vomiting;  and  even 
then,  where  the  vomiting  was  not  inflammatory,  I  have 
given  it,  and  it  has  arrested  the  vomiting.  Though 
this  disease  in  general  should  be  treated  by  active 
antiphlogistic  measures,  yet  it  permits  the  exhibition 
of  wine,  quinine  and  porter ;  and  though  we  adopt  an 
antiphlogistic  course,  yet  it  does  not  bear  those  vacua- 
tions  which  other  inflammatory  diseases  do.  It  sooner 
requires  supporting  measures,  and  a  larger  number  of 
cases  require  support,  than  perhaps  in  any  other  inflam- 
mation. 

In  a  word,  to  sum  up  a  general  treatment,  if  rhubarb 
or  castor  oil  does  not  exert  a  decided  influence,  you 
must  resort  to  mercurials  and  nauseants.  Ipecac,  is 
my  favorite,  followed  freely  by  the  sulphate  of  quinine, 
which  article  I  cannot  recommend  too  highly.  Opium 
is  frequently  serviceable,  and  cupping  to  the  neighbor- 
ing sound  parts,  with  me,  is  much  preferable  to  bleed- 
ing; caustic  potash,  and  the  sesqui-carbonate  of  potash 
are  valuable  auxiliaries ;  blisters,  cold  or  tepid  applica- 
tions, as  well  as  depletion,  should  be  used  with  extreme 
caution.  Mercurial  ointment,  acetate  of  lead  and  sul- 
phate of  zinc,  (sugar  lead  and  white  vitriol,)  tincture 
of  iodine,  and  nitrate  of  silver,  are  good  applications 
locally,  and  in  the  phlegmonous  form,  as  we  have  be- 
fore described,  free  incisions  should  be  resorted  to,  to 
prevent  the  pus  from  burrowing  in  the  cellular  tissue. 

In  respect  to  local  applications,  in  addition  to  those 
already  recommended,  the  following  are  highly  extolled, 
especially  if  there  be  vesication,  it  is  a  good  treatment 
to  sprinkle  a  little  calmine  powder  or  starch,  over  the 
inflamed  surface;  others  contend  that  the  oxide  of  zinc 


ERYSIPELAS. 


209 


is  a  valuable  application,  and  a  distinguished  author 
says, — he  experienced  great  relief  from  the  application 
of  blotting  paper,  which  absorbed  the  fluid. 

Mr.  Velpeau  has  employed  the  sulphate  of  iron  with 
advantage,  as  an  application  to  the  inflamed  part.  He 
uses  it  both  in  solution  and  ointment ;  the  following  are 
his  recipes : 

R.    Ferri  sulphat.  gi.  3^.  Ferri  sulphat,  5i. 

Aquae,  Oj. — M.        Adipis,  51. — M. 

he  asserts  that  these  applications  exert  a  great  control 
over  the  inflammation,  generally  subduing  it  in  two 
days. 

Dr.  Dunglison  recommends  methodical  compression, 
says  it  is  quite  efficacious. 

Tonic  remedies  are  more  essentially  necessary,  where 
the  inflamed  parts  exhibit  a  tendency  to  gangrene. 

The  following  topical  remedy  is  used  by  Dr.  Ewing, 
in  gangrene,  and  it  is  a  valuable  application, — charcoal, 
slippery  elm,  and  barks,  made  into  a  poultice.  The 
solution  of  the  chlorides  of  lime  and  soda,  are  valuable 
applications  in  this  stage. 

I  have  used  with  great  success  the  tincture  of  the 
chloride  of  iron,  in  doses  from  ten  to  twenty  drops  in 
water,  repeated  every  two  hours,  it  is  a  valuable  agent 
in  the  treatment  of  erysipelas,  and  is  apt  to  effect  a 
cure  from  three  to  seven  days. 

Infants. — Lam  of  the  opinion  that  infantile  erysipelas 
does  not  differ  in  any  essential  point  from  the  erysipelas 
of  adults.  It  occurs  under  all  the  modifications,  as  to 
its  phenomena  and  progress,  that  it  is  known  to  assume 
at  a  more  advanced  age. 

•14 


210 


INFLAMMATION  OF  THE  BRAIN. 


Treatment. — With  children  it  rarely  admits  of  active 
antiphlogistic  measures.  6  An  obvious  tendency  to  pros- 
tration, in  a  large  majority  of  cases/  occurs  almost  as 
soon  as  the  inflammation  makes  its  appearance;  the 
fever  in  general  assumes  a  typhoid  type  from  the  onset 
of  the  malady.  The  treatment,  separate  and  apart 
from  the  antiphlogistic  course,  does  not  diner  from  that 
recommended  for  adults. 

Where  there  is  an  evident  tendency  to  prostration,  I 
have  used  the  carbonate  of  ammonia  in  conjunction 
with  quinine,  with  signal  advantage.  In  a  conversation 
with  Doctors  Bryan,  Minnock  and  Irion,  they  assured 
me  that  they  used  spirits  of  turpentine  internally,  with 
benefit  to  children ;  they  give  from  two  to  three  drops 
every  four  hours,  to  an  infant  six  weeks  old. 

If  the  parts  assume  a  gangrenous  character,  a  local 
application  of  charcoal,  a  decoction  of  oak  bark,  with  a 
small  portion  of  yeast,  is  a  most  excellent  poultice. 


PHEENITIS.  ' 

(INFLAMMATION  OF  THE  BRAIN  AND  ITS  MEMBRANES.) 

Phrenitis. — This  is  one  of  the  most  important  subjects 
for  medical  investigation.  In  order  to  understand  any 
disease,  and  more  especially  this,  in  my  opinion,  it  is 
absolutely  necessary  to  have  seen  it,  to  have  carefully 
watched  it,  and  traced  it  through  its  different  stages 
during  life,  and  to  note  the  vestiges  which  it  may  have 
left  behind  after  death.    Good  descriptions  of  disease 


INFLAMMATION  OF  THE  BRAIN. 


211 


never  can  be  substituted  for  the  actual  observation  of 
disease  at  the  bedside ;  and  here  you  will  find  how 
necessary  it  is  to  have  been  thoroughly  instructed  h> 
diagnosis,  one  of  the  most  important  qualifications  of  a 
physician,  whilst,  at  the  same  time,  the  principal  branch 
of  pathology,  and  without  doubt  the  most  difficult.  But 
it  is  the  only  basis  on  which  we  can  found  a  just  prog- 
nosis and  rational  treatment.  I  shall  cite  an  example, 
merely  to  show  my  young  professional  brethren,  that 
an  accomplished  diagnosticator  has  but  little  difficulty 
in  ascertaining  the  seat  and  nature  of  a  disease,  even  in 
cases  wherein  serious  obstacles  may  present  themselves. 
Let  us  suppose  an  example. 

A  patient  is  presented  in  a  state  of  complete  loss  of 
consciousness.  It  is  impossible  to  obtain  from  him  any 
information  with  respect  to  his  present  feelings  or  con- 
dition, or  any  clue  to  the  previous  history  of  his  case. 
TVre  are  informed  by  those  present,  that,  up  to  the  period 
of  his  illness,  he  was  in  the  enjoyment  of  perfect  health, 
and  that  the  present  attack  was  sudden.  Having  no 
other  sources  of  information  as  to  the  nature  of  the  case, 
we  call  in  our  senses  and  reason  to  our  aid  in  forming  a 
diagnosis.  The  former  tells  us  that  he  is  advanced  in 
years,  of  a  robust  frame,  the  several  cavities  large,  his 
limbs  well  developed,  his  face  flushed,  eyes  prominent, 
the  temporal  and  carotid  arteries  beating  with  violence, 
frothing  at  the  mouth,  his  extremities  cold,  that  one 
side  of  the  body  is  deprived  of  motion,  that  the  pulse  is 
strong  and  hard,  that  he  has  vomiting,  and  that  he  has 
passed  his  faeces  involuntarily,  that  the  breathing  is 
stertorous.  Now  what  is  to  be  done  in  this  case  ?  Do 
you  not  see  in  a  moment  what  the  disease  is,  its  nature, 
seat,  extent,  and  the  indications  of  treatment  ?    We  will 


212 


INFLAMMATION  OF  THE  BRAIN. 


now  reason  on  the  case.  There  is  complete  loss  of  con- 
sciousness. What  are  the  diseases  which  give  rise  to 
•this  symptom  ?  They  are  diseases  of  the  heart,  of  the 
lungs,  and  of  the  brain.  Is  the  heart  the  seat  of  the 
disease  at  present  ?  No,  for  the  patient  was  very  well 
before  the  attack,  and  the  circulation  was  not  disturbed. 
Is  it  syncope  (fainting  or  swooning)  ?  No,  for  the  face 
is  flushed,  and  the  pulse  is  strong  and  full.  Is  it 
asphyxia  (suffocation)  ?  No,  for  the  respiration  and 
circulation  still  exists,  and  there  was  no  asphyxiating 
cause.  The  brain  therefore  must  be  the  organ  involved. 
We  have  now  placed  the  disease  in  the  brain,  but  the 
diseases  of  this  organ  are  numerous.  The  disease  is 
evidently  not  chronic,  for  the  patient  was  very  well  a 
little  before  the  attack.  Thus,  then,  by  this  single 
trait,  we  have  got  rid  of  one-half  of  the  cerebral  affec- 
tions. We  now  have  left  for  consideration  arachnitis, 
(inflammation  of  the  arachnoid  membrane,)  cerebral 
congestion,  softening,  haemorrhage ;  it  cannot  be  conges- 
tion, for  congestion  is  a  general  disease,  and  here  there 
are  local  phenomena ;  nor  can  it  be  arachnitis,  for  the 
same  reason.  It  must,  therefore,  be  either  softening  or 
effusion ;  but  the  progress  of  softening,  which  also  pro- 
duces hemiplegia,  (paralysis  of  one  side  of  the  body,)  is 
slow  and  gradual,  and  here  the  disease  came  on  sud- 
denly. The  case,  therefore,  must  be  one  of  a  cerebral 
haemorrhage,  or  apoplexy.  Thus,  then,  have  we  come, 
by  the  mere  application  of  the  senses  and  by  reasoning, 
to  ascertain  the  nature,  seat,  and  extent  of  the  disease, 
which  we  have  before  our  eyes,  and  that  with  almost 
mathematical  certainty. 

Acute  inflammation  appears  to  attack  at  times  the 
whole  of  the  contents  of  the  skull.    "  As  the  contents 


INFLAMMATION  OF  THE  BRAIN. 


213 


of  the  cranium  are  called  collectively  the  encephalon," 
some  call  this  disorder  encephalitis,  hut  I  ado\)t  Cullen, 
and  term  it  pkrenitis. 

" Phrenitis,  or  acute  and  general  inflammation  of  the 
brain  and  its  membranes,  as  it  occurs  in  adults,  presents 
two  periods,  which  are  marked  by  different  symptoms, 
and  in  most  instances^  are  very  distinctly  observable," 
they  are  sometimes  mixed  and  confounded  together. 
But  the  distinction  is  real,  and  the  physician  should 
give  it  close  observation. 

The  symptoms  that  characterise  the  period  of  excite- 
ment are  pain  of  the  head,  often  intense  and  deeply 
seated  or  extending  over  a  large  part  of  it ;  a  feeling  of 
constriction  across  the  forehead,  throbbing  of  the  tem- 
poral arteries,  flushing  of  the  face,  injection  of  the  eyes, 
which  generally  have  a  wild  and  brilliant  look,  con- 
traction of  the  pupils,  preternatural  sensibility  to  ex- 
ternal impressions,  amounting  frequently  to  impatience 
of  light  and  sound;  a  disposition  to  get  out  of  bed, 
violent  delirium,  want  of  sleep,  frequent  paroxj'sms  of 
general  convulsion,  a  parched  and  dry  skin,  a  frequent 
and  hard  pulse,  a  white  tongue,  thirst,  nausea  and 
vomiting,  with  generally  great  constipation  of  the 
bowels. 

The  attacks  come  on  in  various  ways,  and  you  are 
not  to  look  for  all  the  symptoms  here  laid  down  in  every 
case,  from  the  fact  that  it  is  frequently  ushered  in  with 
a  sudden  alteration  of  manner,  frequently  with  nausea 
and  vomiting;  but  the  symptoms  are  generally  so 
prominent  in  regard  to  the  head,  that  it  will  fix  your 
attention  there.  Another  important  fact  is  the  fre- 
quency with  which  inflammation  of  the  dura  mater 
supervenes  upon  otitis,  (inflammation  of  the  internal  ear.) 


214 


INFLAMMATION  OF  THE  BRAIN. 


and  this  should  be  kept  constantly  in  mind;  for  it  is  only 
by  a  prompt  action  and  judicious  treatment  whilst  the 
disease  is  confined  to  the  internal  ear  that  we  can  have 
any  hopes  of  saving  the  patient.  (Dr.  McCraven  and 
my  self  attended  a  case  in  this  city  where  the  attending 
physician  treated  the  otitis  as  the  result  of  cold,  with 
simple  remedies,  when,  at  the  time,  it  needed  the  most 
active  remedies.)  When  the  inflammation  has  extended 
to  the  dura  mater,  the  termination  is  almost  generally 
fatal. 

"Again,  some  cases  of  acute  inflammation  of  the  brain 
set  in  neither  with  sudden  and  great  disturbance  of  the 
intellectual  functions,  nor  with  sickness  and  vomiting, 
but  with  a  paroxysm  of  general  convulsion,  such  as  often 
ushers  in  an  attack  of  meningitis."  (Inflammation  of 
the  membranes  of  the  brain  or  spinal  cord.)  This 
symptom,  M.  Andral  affirms,  is  a  more  certain  sign  of 
cerebral  inflammation  than  the  occurrence  of  delirium. 
From  the  variety,  you  see  the  importance  of  your  re- 
membering that  inflammation  of  the  brain  commences 
in  three  different  ways.  And  there  is  even  another; 
M.  Andral  states  that  he  has  seen  a  few  instances  of 
inflammation  of  the  brain,  of  which  the  first  sign  was  a 
sudden  loss  of  the  power  of  speech. 

I  venture  the  opinion  that  phrenitis,  in  many  instan- 
ces, has  produced  such  morbid  vascular  action  as  fre- 
quently to  terminate  in  such  a  complete  alteration  in 
the  structure  of  the  brain  as  to  end  in  incurable  mania, 
without  fever. 

After  the  symptoms  related  continue  for  twelve  hours 
or  more,  they  are  generally  followed  by  twitchings  of 
his  muscles,  and  startings  of  their  tendons  come  on, 
sometimes  his  limbs  are  agitated,  cold  sweats  break  out, 


INFLAMMATION  OF  THE  BRAIN. 


215 


the  sphincters  relax,  he  falls  into  a  profound  sleep,  and 
life  is  gone ;  these  symptoms  I  regard  as  more  certain 
indications  of  inflammation  than  the  symptoms  which 
present  in  respect  to  the  intellect. 

Causes. — This  disease  is  more  frequently  the  ac- 
companiment of  fever  than  of  any  other  disease.  It  is 
frequently  the  result  of  colds,  especially  when  over- 
heated. It  will  occur  also  from  heat  alone,  especially 
if  exposed  to  the  direct  rays  of  the  sun.  Mental  irrita- 
tion, want  of  sleep,  or  long  continued  watchings  will 
sometinjes  produce  it. 

It  is  asserted  that  a  cessation  of  the  itch  has  been 
followed  by  phrenitis.  Dr.  Elliotson  attaches  much 
importance  to  inflammations  of  the  eye,  or  the  ear,  or 
the  nose,  or  the  frontal  sinuses,  will  sometimes  spread 
to  the  brain.  I  have  myself  seen  two  or  three  such 
cases.  Phrenitis  has  frequently  carried  off  patients  who 
have  had  nothing  more,  at  first,  than  inflammation  of 
the  parts  I  have  just  enumerated.  Of  course  inflamma- 
tion will  spread  in  the  head  just  as  in  other  parts  of  the 
body.  When  the  nose  and  sinuses  have  been  inflamed, 
the  bones  in  many  cases  have  been  carious. 

Dr.  Elliotson  again  says,  "I  have  several  times  seen 
phrenitis  arise  from  disease  of  the  ear,  and  once  saw 
gangrene  of  the  dura  mater,  from  a  case  of  this  descrip- 
tion." (I  have  also  seen  it :  I  have  alluded  before  to  a 
similar  case.)  He  says,  "When  a  person  has  a  dis- 
charge from  the  ea^,  or  ear  ache,  we  ought  to  be  on  our 
guard  to  notice  the  first  symptoms  he  may  mention  of 
pain  in  the  head,  or  the  first  anxious  look  that  is  dis- 
played. The  very  slightest  symptoms  of  cerebral  affection, 
when  there  is  a  cessation  of  discharge  from  the  ear,  ought 
to  put  us  on  our  guard."    He  says  he  has  seen  a  number 


216 


INFLAMMATION  OF  THE  BRAIN. 


of  cases  of  this  description,  where  persons  have  had 
phrenitis  after  pain  of  the  ear,  or  a  discharge  from  that 
organ. 

Phrenitis,  it  is  said,  has  been  the  result  of  a  cessation 
of  the  mumps,  and  it  has  been  known  to  occur  on  the 
cessation  of  inflammation  of  the  testicle,  and  we  know 
that  it  certainly  does  occur  in  the  way  of  metastasis, 
when  Rheumatism  ceases  in  the  joints,  or  gout  ceases  in 
some  situations.  Exciting  causes,  such  as  blows,  &c, 
will  produce  it.  % 

,  Prognosis. — Inflammation  of  the  brain  may, .indeed, 
be  regarded  as  a  dangerous  and  very  alarming  disease ; 
it  often  proves  fatal  in  a  very  short  period,  but  more 
frequently  between  the  third  and  seventh  day;  if  pro- 
tracted beyond  this,  it  is  apt  to  terminate  in  mania; 
and  in  children  it  is  followed  by  dropsy  of  the  brain. 

Treatment. — Energetic  measures  are  of  the  utmost 
importance  to  begin  the  treatment  with,  and  that  early. 
Although  I  am  but  a  poor  advocate  for  the  lancet,  espe- 
cially in  this  climate,  yet  to  meet  the  urgency  that  is 
required  to  combat  successfully  this  disease,  I  know  of 
nothing  as  yet  equal  to  the  lancet;  and  the  great  object 
must  be,  when  you  use  it,  not  to  bleed  for  quantity,  but 
bleed  for  effect  ;  and  to  do  this  correctly,  you  will  con- 
tinue the  bleeding  until  the  pulse  begins  perceptibly  to 
flag,  except  only  in  the  case  of  hypertrophy  (enlarge- 
ment) of  the  left  ventricle  of  the  heart.  If  the  pulse 
remains  tense,  and  the  active  cerebral  symptoms  are 
unabated,  in  which  case  the  bleeding  can  be  resorted  to 
again,  I  prefer  bleeding  in  the  temporal  artery.  Cups 
should  be  applied  to  the  temples  and  behind  the  ears, 
and  frequently  will  relieve  if  applied  to  the  stomach  and 
abdomen.    Leeches  do  better  when  they  can  be  had. 


INFLAMMATION  OF  TIIE  BRAIN.  217 

A  vast  deal  depends,  as  to  the  result,  on  the  abstraction 
of  blood,  both  general  and  local.  To  assist  in  reducing 
the  arterial  action,  I  have  frequently  administered  acon- 
ite, a  few  drops  put  into  an  ounce  or  two  of  water,  and 
give  teaspoonful  every  15  or  20  minutes. 

Active  hypercatharsis  (purging)  should  be  produced 
as  speedily  as  possible,  as  there  is  always  severe  consti- 
pation. Some  advocate  calomel.  I  have  never  seen  any 
necessity,  or  more  properly,  I  have  never  witnessed,  in 
this  disease,  any  benefit  resulting  from  it.  For  the  pur- 
pose of  producing  free  evacuations,  I  generally  prescribe 
the  following: 

I£.    Podophyllin,  gr.  ss. 

Ex.  Jalap,  grs.  iv. 

Comp.  ex.  colocynth,  grs.  v.  ■ 
Mix  and  give,  and  repeat  in  three  hours,  if  necessary. 
Its  operation  should  be  promoted  by  the  subsequent 
administration  of  the  infusion  of  senna  with  epsom 
salts,  or  combination  of  a  similar  character. 

A  combination  of  12  grs.  of  the  nitrate  of  potash,  and 
a  half  grain  of  digitalis,  is  highly  recommended  in  this 
disease.  The  dose  may  be  repeated  every  two  hours. 
I  could  not  be  induced,  with  my  knowledge  at  the  pre- 
sent time,  to  give  digitalis  in  this  disease. 

If  the  stomach  is  not  irritable,  ipecac,  may  be  given 
in  small  doses  every  hour  or  two,  as  the  nausea  pro- 
duced from  it  has  a  tendency  to  lessen  the  force  of  the 
cerebral  congestion ;  vomiting  is  not  desirable,  and  you 
should  not  press  the  ipecac,  to  that  extent. 

Local  applications  are  highly  recommended,  and  there 
is  none  so  effectual  as  cold  water ;  ice  is  preferable,  put 
into  a  bladder,  but  to  be  of  service,  it  must  be  constantly 


218 


INFLAMMATION  OF  THE  BRAIN. 


and  steadily  applied,  intermitting  sufficient  so  as  not  to 
destroy  the  skin,  but  not  so  long  as  to  let  secondary 
re-action  ensue,  for  in  that  event  it  would  produce  more 
harm,  than  its  sedative  influence  would  do  good. 

Most  medical  writers  recommend  shaving  the  head, 
and  applying  blisters  to  the  scalp;  I  must  confess  I 
have  no  confidence  whatever  in  this  mode  of  treatment, 
I  believe  the  cold  applications  can  be  applied  with  the 
hair  on  as  well  as  if  shaved,  and  as  regards  the  blisters 
to  the  scalp,  if  they  were  placed  on  the  extremities,  I 
think  they  would  be  much  more  serviceable. 

During  the  application  of  cold  water  to  the  head,  the 
extremities  should  be  immersed  in  tepid  wrater,  and 
mustard  plasters  to  the  feet. 

I  am  of  the  opinion  that  a  large  blister  to  the  nape  of 
the  neck,  will  sometimes  be  of  benefit. 

Opiates  and  anodyne  narcotics,  though  entirely  for- 
bidden in  the  early  stage,  may  sometimes  be  safely  and 
usefully  employed  to  control  the  restlessness  remaining 
after  the  inflammation  has  gone. 

Attention  should  be  directed  to  the  bladder ;  the 
head  should  be  elevated,  the  feet  kept  warm;  he  should 
observe  total  abstinence,  free  from  noise  and  perfectly 
quiet. 

"We  may  have  a  state  in  the  after  treatment  of  this 
disease,  in  which  nourishment  and  even  opium  will  be 
necessary, — at  the  close  of  phrenitis,  if  there  has  been 
too  much  purging,  -delirium  will  still  remain ;  in  this 
case  you  resort  to  the  remedies  above.  "When  on  the 
subject  of  delirium  tremens,  we  will  allude  to  this  state 
again. 

I  have  already  assured  you  of  the  value  of  podo- 
phyllin  in  this  disease,  and  you  will  find  no  remedy 


INFLAMMATION  OF  THE  BRAIN. 


219 


manifesting  a  higher  degree  of  value,  in  controlling 
inflammation  of  the  brain,  or  relieving  congestion  of 
blood  to  that  organ. 

I  have  alluded  to  hamospasls  (dry  cupping,)  under 
the  head  of  congestive  fever, — I  believe  this  principle 
was  first  suggested  in  this  country  by  the  able  and 
scientific  Dr.  Buchanan,  of  Cincinnati,  and  as  he  places 
a  great  estimate  upon  it  in  this  disease  and  many 
others,  I  cannot  do  better  than  to  report  it  in  full. 

"Any  thing  capable  of  drawing  blood  to  a  part  may 
be  said  to  act  ha3inospastically.  It  is  a  powerful  revulsive 
treatment.  Dry  cupping  does  so;  it  not  only  draws 
the  blood  from  internal  parts  to  the  surface,  but  like- 
wise attracts  morbid  action,  and  thus  affords  relief. 
Common  half-pint  tumblers  will  answer  for  adults  very 
well,  in  place  of  ordinary  cupping  glasses.  A  piece  of 
paper  or  cotton,  rolled  up,  and  fired,  and  dropped  into 
the  tumbler,  and  allowed  to  burn  a  minute  or  two,  fits 
the  tumbler  for  application  to  the  spot.  One,  two,  or 
more  may  be  applied,  and  repeated  as  often  as  may  be 
desirable  :  they  should  remain  until  ready  to  fall  off. 
Intermittent  fever  has  been  invariably  cured  by  M. 
Condret,  by  applying  eight  or  ten  middle  sized  cupping 
glasses,  on  each  side  of  the  spinal  column,  from  the 
neck  downwards,  and  allowing  them  to  remain  for 
about  thirty  or  forty  minutes.  To  be  applied  at  the 
commencement  of  the  cold  stage.  One  to  four  appli- 
cations effect  the  cure.  Also  useful  in  cases  of  diffi- 
cult respiration  from  congestion  of  the  lungs  or  mucous 
membrane  of  the  bronchii,  etc. 

"  Ecemastasis,  a  term  applied  to  the  retention  of 
venous  blood  in  the  extremities  by  ligature.  Tie  a 
handkerchief,  or  any  suitable  cord  around  the  upper 


220 


OPHTHALMIA. 


part  of  the  arms,  and  the  thighs,  and  then,  by  means  of 
a  piece  of  wood,  twist  or  turn  the  cord  sufficiently  tight 
to  check  the  circulation  of  the  venous  blood,  but  not 
the  arterial,  which  may  be  known  by  the  action  of  the 
pulse.  In  a  short  time  the  arms  and  legs  will  be  much 
distended,  and  an  amount  of  blood  removed  from  the 
trunk  and  retained  in  the  limbs,  which  the  most  heroic 
practitioner  dare  not  remove  by  the  lancet.  If  the  sub- 
ject faint,  promptly  loosen  or  remove  the  ligatures ;  if 
he  be  plethoric,  and  of  firm,  vigorous  constitution,  he 
must  be  reduced  by  cathartics,  diuretics,  sudorifics,  and 
be  under  the  influence  of  gentle  nauseants,  at  the  time 
of  the  operation.  This  is  found  very  useful  in  uterine 
haemorrhage,  hemoptysis,  and  other  haemorrhages,  in- 
flammations of  the  brain,  lungs,  bowels,  etc.,  conges- 
tions, puerperal  convulsions,  and  wherever  it  is  deemed 
advisable  to  lessen  the  amount  of  blood  in  the  head  and 
trunk,  without  injuring  the  system." 

The  following  cataplasm  is  a  good  revulsive,  when 
applied  to  the  feet  in  this  disease : 

Ify.    Bruised  horseradish,  3vi. 


Mustard  seed,  Pulv., 
Flaxseed  meal, 
Vinegar, 


Si. 

Siiss. 
q.  s. 


Mix  and  make  cataplasm. 


DISEASES  OF  THE  EYE, 


OPHTHALMIA. 


The  eye  is  the  agent  that  controls  most  of  our  other 
senses.    Its  structure  is,  without  doubt,  the  most  deli- 


OPHTHALMIA. 


221 


cate  and  diversified  of  any  other  organ  in  the  animal 
economy ;  and,  from  its  constant  use,  it  is  liable  to  a 
number  of  accidents  and  diseases. 

Ophthalmia  is  the  genuine  term  for  inflammatory 
diseases  of  the  eye.  The  simple  (xmjtmctivitis,  or  inflam- 
mation of  the  mucous  membrane  covering  the  front  of 
the  eyeball  and  lining  the  eyelids,  is  the  most  frequent 
form,  and  it  is  attended  with  pain,  redness,  intolerance 
of  light,  and  frequently  a  sensation  as  if  sand  was  in 
the  eyes.  The  causes  that  produce  this  form  of  oph- 
thalmia are  various,  such  as  external  injuries,  exposing 
the  eye  to  a  strong  wind,  also  to  intense  light,  heat,  or 
to  dust.  Inflammatory  tumours,  called  styes,  often  pro- 
duce it.  There  are  several  varieties  of  conjunctivitis  of 
sufficient  importance  to  require  distinction. 

Before  we  enter  into  a  description  of  the  several 
varieties,  I  wish  to  impress  upon  the  general  practitioner 
of  medicine,  that  he  ought  to  be  competent  not  only  to 
treat  all  acute  diseases  of  this  important  organ,  together 
with  its  simpler  and  more  common  forms  of  chronic 
derangement,  but  to  distinguish  these,  with  readiness 
and  accuracy,  from  the  rarer  and  more  complex  malfor- 
mations or  disorganizations,  which  may  justify  him  in 
referring  the  case  to  professed  eye  doctors.  Although 
you  may  not  propose  to  become  professional  occulists  or 
exclusively  "  operative"  surgeons,  you  are  still  bound  to 
study  and  discriminate  many  of  the  diseases  fully  treated 
of  only  in  works  devoted  to  this  one  organ. 

Simple  conjunctivitis  is  sometimes  symptomatic  of 
other  diseases,  such  as  measles,  small  pox,  scrofula,  and 
syphilis. 

Treatment. — There  is  very  little  treatment  required 


222 


OPHTHALMIA. 


in  the  early  stage  of  the  disease,  if  proper  remedial 
measures  are  adopted.  Cold  water  through  the  day, 
with  an  application  of  slippery  elm,  will  be  all  sufficient, 
generally.  A  very  soothing  application  is  to  take  the 
green  leaves  of  scrofularia  marylandica,  (some  call  it 
water  betony,)  this,  in  combination  with  appropriate 
regimen,  will  very  soon  relieve  every  trace  of  inflam- 
mation ;  the  pith  of  sassafras  is  also  a  good  local  appli- 
cation. 

It  is  said  in  obstinate  cases,  that  an  infusion  of 
hydrastus  canadensis,  (yellow  root  or  tumeric  root,) 
with  the  addition  of  borax,  (3ii  to  the  pint,)  may  be 
used  with  good  effect.  In  such  cases  I  resort  to  cup- 
ping, and  I  apply  a  seton  behind  each  ear,  if  the  case  is 
one  of  great  obstinacy.  This  should  be  preceded  by  an 
emetic,  either  lobelia  or  ipecac,  given  at  such  time  and 
in  such  quantities  as  to  produce  vomiting  two  or  three 
times  in  the  course  of  the  day.  After  this,  you  should 
administer  a  cathartic  of  senna  and  epsom  salts,  or 
cream  of  tartar  and  jalap,  and  if  the  biliary  secretions 
are  in  the  least  suspended,  you  should  add  to  the  fore- 
going a  half  grain  or  grain  of  podophyllin. 

If  this  treatment  should  not  lessen  the  inflammatory 
symptoms,  the  alcoholic  sweat  must  be  resorted  to, 
(page  39,)  with  a  continuation  of  the  emetic  and 
cathartic  remedies.  This  will  generally  remove  all  the 
acute  symptoms,  but  it  is  sometimes  followed  by  a 
chronic  form. 

The  following  remedies  are  valuable  applications  in 
this  stage.  Take  alum  and  the  white  of  an  egg,  agitate 
until  a  coagulum  be  formed,  put  it  in  a  linen  rag  and 
apply  to  the  eyes. 


OPHTHALMIA. 


223 


Ex.  Opii  Mollis  gr.  x. 
Camphor     gr.  vi. 
Hot  water  or  orange  water  3  xii. 

Rub  the  two  first  ingredients  well  together  and  add 
the  water — strain  before  using. 
Also, 

^.    Poppies,  5  iv. 

Aquae  rosarum  (rose  water.) 
Misturae  C amphorae,  aa,  %  ii. 

Misce. — Either  of  these  can  be  successfully  applied  to 
the  eye  by  introducing  a  small  syringe  into  the  outer 
angle  and  injecting  them. 

I^.    Liquoris  ammonias  acetatis,  5  ii- 

Aquae  ferventis,  %  vi.  (hot  water.) 

Ex.  Opii,  grs.  x. 

Dissolve  the  opii  in  the  water,  strain,  and  add  the 
ammoniae.  This  is  a  valuable  remedy  in  this  form  of 
the  disease,  when  there  is  considerable  pain. 

In  acute  ophthalmia,  when  there  is  great  sensibility, 
the  following  anodyne  collyrium  will  be  found  to  answer 
well. 

1^.    Colchici  autumnalis,  3  i-  (meadow  saffron.) 
Aquae  Lini  bullientis,  3  hi.  (hot  flaxseed  water.) 
Tincture  opii,  5  i.    Mix,  and  apply. 

In  acute  ophthalmia,  when  you  wish  to  promote  ab- 
sorption, the  following  is  valuable  : 

fy.    Nitratis  Argenti,  gr.  i  to  ii.  (Lunar  caustic.) 

Distilled  water,   %  ii.  Mix  in  solution  and  apply. 

When  the  inflammation  becomes  sub-acute,  or  the 
active  stage  has  passed,  it  is  then  that  the  preparations 


224 


OPHTHALMIA. 


of  lead,  vitriol,  and  the  chloride  of  mercury  or  lime  will 
prove  beneficial,  and  in  such  circumstances  you  can  use 
the  following : 

fy.    White  vitriol,  grs.  x. 
Sugar  of  lead,  grs.  x. 
Tinct.  Opii,    3  iss. 
Aqua  purse,    5  viii. 

This  should  be  applied  with  a  linen  rag  five  or  six 
times  a  day,  use  without  shaking. 

It  will  very  seldom  happen  that  the  change  from  the 
acute  to  the  chronic  forms  takes  place,  if  the  remedies 
here  suggested  have  been  properly  applied,  but  it  may 
do  so,  especially  if  you  have  a  scrofulous  patient.  In 
the  chronic  form  you  must  abandon  your  active  deple- 
tive measures,  and  your  local  applications  must  be  of  a 
more  stimulating  character.  If  your  patient  should 
have  a  scrofulous  diathesis,  you  should  put  him  on  an 
alterative  course,  and  you  will  find  the  following  recipe 
will  fulfil  your  expectations. 

ty.    Sarsaparilla,  I  lb. 

Liquorice  root,  1  lb. 

Burdock,  1  lb. 

Sassafras,  I  lb. 

Guaiac,  1  lb. 

Elecampane,  g  vi. 

Kose  leaves,  5  vi. 

Make  a  gallon  and  a  half  of  syrup.  Dose,  two  to  three 
tea-spoonfuls  four  times  a  day,  before  each  meal,  and  at 
bed-time.  » 

You  will  find  a  good  local  application  in  the  tincture 


OPHTHALMIA. 


225 


of  capsicum,  diluted  with  twice  the  amount  of  water, 
after  a  few  days  you  can  use  it  pure. 

In  the  chronic  form  of  the  disease  you  will  frequently 
have  it  to  prove  very  obstinate;  under  such  circum- 
stances you  can  apply  a  blister  to  the  nape  of  the  neck 
and  behind  the  ears ;  after  it  has  drawn,  it  would  be 
well  to  keep,  the  surface  irritated,  so  as  to  produce  a 
constant  drain  from  it. 

In  this  particular  form,  the  eye  assumes  a  peculiar 
weakness,  and  it  is  here  that  your  stimulating  collysia 
must  be  applied.  Some  speak  in  high  terms  of  cin- 
chona, canis  florida,  (dog-wood)  and  the  pyroligneous 
acid. 

In  the  chronic  form  of  this  disease,  you  will  derive 
much  benefit  from  any  of  the  following : 

fy.    Sulphate  of  cadmium,  grs.  iss. — (Cobalt.) 
Laudanum,  gtts.  xx. 

Rose  water,  f.  giv. 

Mix  and  use  as  a  wash. 

f  •  ' 

Hydrastis,  (yellow  root)  if  made  into  decoction,  is  .a 
good  wash  in  the  chronic  form. 

^.    Pulv.  alum,  grs.  xii.  to  xx. 

Rose  water,  f.  si  v. 

Make  a  solution  and  apply  to  the  eye. 

The  following  will  be  found  a  good  astringent  and 
stimulating  remedy : 

Jfa    Liquoris  ammoniae  acetatis,  5ii. 
Mixture  camphor,  £vi. 

Mix,  and  apply  to  the  eyes.. 
15 


226 


CATARRHAL  OPHTHALMIA. 


We  have  cured  the  most  obstinate  cases  of  opthalmia, 
with  the  following  decoction,  as  a  collyrium,  viz : 

ty.    Witch  hazel  bark. 
Golden  seal. 

Lobelia  leaves,  equal  parts. 

The  first  two  made  into  a  strong  decoction,  after  which  add 
the  lobelia  to  the  hot  liquid — cover,  when  cold,  strain. 

Dose  of  decoction,  two  to  four  ounces,  three  or  four 
times  a^day. 

The  compound  collyrium  of  golden  seal,  is  a  most 
excellent  local  application  in  chronic  ophthalmic  dis- 
eases, it  is  prepared  as  follows : 

To  a  strong  decoction  of  green  tea,  and  golden  seal, 
of  each  one  pint,  add  sulphate  of  zinc,  gunpowder  and 
dried  sulphate  of  iron,  of  each  two  drachms.  Let  them 
dissolve,  and  after  decomposition  has  ceased,  and  the 
precipitate  has  subsided,  pour  off  the  supernatal  liquid. 
Apply  it  three  or  four  times  a-day. 

Black  cohosh,  in  doses  of  one  drachm  of  the  tincture 
every  hour,  is  a  valuable  remedy  for  simple  sore  eyes, 
without  the  aid  of  any  local  application. 

Catarrhal  and  Purulent  Ophthalmia,  often  arise  from 
exposure  of  the  eyes  to  dust,  and  hairs  of  the  eyelids 
frequently  produce  it.  It  is  said  to  be  communicable 
from  one  to  another;  my  experience  does  not  justify 
me  in  giving  an  opinion.  Children  are  very  subject  to 
it,  soon  after  birth.  The  secretion  of  tears  is  always 
much  increased,  and  the  purulent  discharge  is  very 
considerable. 

Treatment. — The  chronic  form  in  this  variety,  is  very 
quickly  assumed — your  local  applications  should  be  of 
a  stimulating  character ;  the  general  treatment  is  much 


CATARRHAL  OPHTHALMIA. 


227 


the  same  as  in  the  chronic  form  of  ophthalmia.  To 
arrest  the  inflammation,  I  generally  use  cooling  and 
astringent  washes,  applied  by  means  of  wet  pledgets ;  a 
most  excellent  application  is  three  or  four  grains  of 
nitrate  of  silver,  (lunar  caustic)  to  an  ounce  of  water; 
this  can  be  used  as  directed.  An  ointment  of  the  red 
oxide  of  mercury  will  allay  irritation.  Some  extol 
alum  curd  and  the  spirits  of  turpentine ;  but  you  will 
find  in  this  peculiar  variety  of  ophthalmia,  no  remedy 
equal  to  the  pyroligneous  acid. 

1  Some  authors  speak  in  high  terms  of  the  tincture 
of  myrrh  in  purulent  opthalmia,  they  use  the  saturated 
tincture  of  myrrh.  Saturate  a  linen  cloth  and  apply 
over  the  eyes.  The  following  formula  is  most  excellent 
in  the  purulent  form  : 

fy.    Sulphatis  cupri,  grs.  v. — (Sulphate  of  copper.) 
Camphor,  5i. 
Hot  water,  Sviii. 

Rub  the  camphor  with  the  water,  then  strain,  and 
add  the  copper.    A  good  application  to  infants. 

Scrofulous  Inflammation  of  the  eyes,  is  generally  met 
with  in  those  persons  who  have  a  scrofulous  diathesis, 
and  occasionally  it  presents  (almost  similar,)  as  the 
result  of  venereal  disease,  it  is  generally  very  ob- 
stinate; in  this  variety  of  the  disease,  special  attention 
is  of  course  required  to  the  state  of  the  constitution. 
The  most  peculiar  symptoms  are  irritability  and  in- 
tolerance of  light,  with  little  or  no  pain ;  occasionally 
there  are  pustules  or  ulcerated  spots  upon  it.  I  am 
satisfied  in  this  variety,  that  quinine  and  the  scrofulous 
recipe,  on  page  228,  in  addition  with  iodine  or  hydrio- 
date  of  potash,  will  be  found  of  greater  service  than 
almost  any  other  remedies. 


228  .     SCROFULOUS  OPHTHALMIA. 

Scrofulous  Ophthalmia. — I  advise  the  use  of  the  scro- 
fulous syrup,  especially  in  this  form  of  the  disease,  and 
alternate  it  with  iodine,  ten  drops  three  times  a  day, 
or  two  or  three  grains  of  the  hydryodate  potash  given 
as  often. 

Local  applications,  and  strong  ones,  are  often  neces- 
sary. If  the  disease  has  advanced  to  ulceration  or  pus- 
tulation,  the  dissolved  caustic  will  be  found  a  valuable 
application. 

I  have  used  the  following  in  scrofulous  ophthalmia 
and  ulcerations  of  the  cornea  and  conjunctiva  with  ben- 
efit, viz. : 

R.    Rose  water,  Svi. 

Ioduretti  Potassii,  gr.  xxiv. 
Iodini,  gr.  i. 

Mix,  and  apply  three  or  four  times  a  day. 
The  annexed  ointment  will  be  found  highly  emca- 
cious,  if  applied  to  the  edges  of  the  eye-lids  in  this  vari- 
ety of  the  disease. 

Red  oxide  of  mercury,  1  part. 
Sulphate  of  zinc,         2  parts. 
Lard,  96  parts. 

Rub  well  together. 

When  you  have  scrofulous  ophthalmia  in  connexion 
with  a  rheumatic  affection,  which  is  frequently  assumed 
in  inflammation  of  the  eyes,  you  will  find  the  following 
a  most  excellent  application. 

fy.    Ferrocyanide  of  zinc,  grs.  x. 
Pulv.  gum  arabic,  3iss. 
Cherry  water,  Siiss. 
Wine  of  opium,  fl.9i. 
Cherry  laurel  water,  fl.Sss. 
Mix  and  apply. 


GONORRHEAL  OPHTHALMIA. 


229 


I  have  used  the  tincture  of  capsicum  with  marked 
success  in  this  form  of  ophthalmia. 

Gonorrheal  Ophthalmia. — With  this  unfortunate  di- 
sease I  have  had  no  experience;  but  an  author  of 
some  celebrity  recommends,  without  hesitation,  the 
sanle  general  remedies  and  regimen  as  for  the  ori- 
ginal clap.  I  am  impressed  forcibly  with  the  idea, 
that  if  the  original  disease  could  be  reproduced,  that 
probably  in  cases  where  there  was  great  danger  of 
losing  the  eye,  it  would  be  well ;  as  some  of  the  English 
surgeons  even  go  so  far  as  to  recommend  their  patients 
"to  go  and  get  a  fresh  clap." 

AMAUROSIS. 

GUTTA  SERENA.  DIMNESS  OF  SIGHT. 

This  disease  affects  the  optic  nerve,  and  is  termed 
amaurosis,  and  I  think  might  be  defined  more  properly 
as  paralysis  of  the  optic  nerve.  There  is  dimness  and 
loss  of  sight,  without  any  perceptible  fault  in  the 
humours  of  the  eye.  The  eye  is  generally  lighter 
colored  than  it  should  be;  it  acts  sluggish,  and  the 
pupil  is  generally  dilated;  it  is  sometimes,  however, 
contracted ;  when  it  is,  it  is  the  result  of  irritation  of  the 
third  pair  of  nerves. 

Causes. — The  most  obvious  is  any  excessive  applica- 
tion of  sight,  producing  an  expansion  of  the  optic  nerve, 
or  probably  in  the  course  of  the  nerve  itself.  Some- 
times it  arises  from  softness  of  the  nerve,  and  again 
from  induration  of  the  nerve,  and  sometimes  from 
tumors  pressing  upon  it. 

In  this  disease  there  is  very  frequently  headache,  ver- 
tigo, and  evident  signs  of  cerebral  congestion. 


230 


AMAUROSIS. 


Syphilis  and  mercurialism.  may  be  also  distinguished 
among  remote  causes.  You  can  set  down  congenital 
amaurosis  as  incurable. 

"Dr.  Condie  says,  that  amaurosis  is  frequently  de- 
pendent upon  irritations  seated  within  the  stomach  and 
bowels,  and  upon  derangements  of  the  digestive  organs 
generally,  there  can  be  little  doubt;  he  says  he  has  met 
with  many  cases  of  this  kind,  and  they  are  repeatedly 
referred  to,  more  especially  by  the  German  writers  on 
the  disease.  Complete  blindness  we  have  known  sud- 
denly to  occur  in  consequence  of  the  presence  of  indi- 
gestible food  in  the  stomach,  and  to  be  as  quickly 
removed  upon  its  expulsion. " 

Treatment. — The  large  mass  of  medical  men  sum  up 
their  success,  as  is  done  by  a  distinguished  author  in 
this  sentence.  "I  have  done  all  this,  and  with  a  certain 
degree  of  success ;  but,  (as  I  just  now  said,)  I  hardly 
recollect  a  case,  which,  after  continuing  some  time,  was 
perfectly  cured." 

This  is  not  in  accordance  with  my  experience ;  I  have 
treated  a  few  cases,  some  of  them  of  long  standing,  with 
perfect  success. 

The  first  thing  is  to  prohibit  any  exercise  of  the  eye, 
give  your  patient  occasionally  an  active  cathartic ;  I  am 
in  the  habit  of  giving  an  emetic  once  a  week,  followed 
by  podophyllin  in  combination  with  jalap  or  juglans ; 
the  bowels  in  the  mean  time  should  be  kept  in  a  soluble 
condition  by  means  of  gentle  aperients.  "  The  patient 
should  be  regularly  bathed  once  a  day  in  weak  ley, 
applying  brisk  friction  after  drying ;  the  feet  should  be 
bathed  in  hot  water  every  night  for  a  considerable  time, 
apply  the  irritating  plaster  to  the  whole  cervical  verte- 
bras, let  it  remain  as  long  as  he  can  endure  it,  create 


AMAUROSIS.  231 

two  issues  behind  the  ears,  and  keep  them  open."  Dr. 
Buchanan  recommends  pouring  a  stream  of  water  from 
a  considerable  height  to  a  point  behind  and  above  the 
external  canthus  of  the  eye ;  this  can  be  done  by  hold- 
ing a  funnel  over  this  part;  electricity  exerts  a  very 
good  influence  at  times.  After  following  strictly  these 
directions  you  will  seldom  fail  in  restoring  sight,  if  you 
will  use  the  prussic  acid  vapor  as  recommended  by  Dr. 
Trumbull ;  I  have  used  it  with  complete  success. 

As  regards  local  applications  to  the  eye,  I  confess,  in 
opposition  generally  to  my  medical  brethren,  I  have 
considerable  confidence  in  them,  and  when  your  patient 
can  bear  the  tincture  of  capsicum  directly  applied  to  the 
eye  it  will  not  disappoint  your  expectations.  Commence 
its  use  by  diluting  it,  increasing  its  strength  until  you 
can  use  it  pure.  I  have  experienced  in  some  cases  con- 
siderable benefit  from  the  following : 

I^.    Pure  strychnine,  grs.  ii.  to  iv. 
Dilute  acetic  acid. 
Distilled  water,  aa.  5  i. 

Make  solution,  a  drop  or  two  applied  to  the  eye 
several  times  a  day. 

I  have  used  a  small  blister  over  the  eye-brow,  when 
drawn  remove  the  cuticle,  and  sprinkle  on  the  sixth  of 
a  grain  of  pulverized  strychnine. 


232 


INFLAMMATION  OF  THE  LIVER. 


DISEASES  OF  THE  LIVER, 

INFLAMMATION  OF  THE  LIVER. 

We  will  now  proceed  to  consider  the  diseases  of  an 
organ,  which,  unfortunately,  is  too  frequently,  both  by 
Southern  men  and  Southern  practitioners,  pronounced 
diseased,  and  remedies  directed  thereto,  when,  in  fact, 
it  is  performing  its  functions  in  health — I  mean  the. 
liver.  It  is,  however,  very  subject  to  acute  and  chronic 
inflammation. 

Symptoms  of  Acute  Hepatitis. — The  premonitory  symp- 
toms of  this  affection  are  similar  to  those  of  fever,  espe- 
cially if  the  liver  is  laboring  under  acute  inflammation 
to  any  amount,  when  you  will  have  some  local  signs, 
which  will  soon  indicate  the  character  of  the  affection, 
such  as  pyrexia  (fever)  and  almost  constant  pain, 
chiefly  confined  to  the  right  side.  The  character  of 
the  fever  generally  is  inflammatory,  and  may  become 
typhoid ;  the  skin  is  hot  and  dry ;  the  tongue  covered 
with  a  yellow  fur ;  pulse  full  and  hard,  with  great  thirst, 
and  an  acrid  bitter  taste  in  the  mouth ;  frequently  nau- 
sea and  vomiting ;  urine  scanty  and  very  high  colored, 
depositing  a  lateritious  sediment  (a  brick-like  sediment) ; 
bowels  generally  constipated.  The  local  symptoms  in 
connection  with  those  already  specified  are  numerous. 
There  is  a  sense  of  tension  or  weight.  It  is  said,  and 
by  high  authority  too,  that  if  the  surface  of  the  liver 
suffer,  there  is  mere  tension ;  whereas,  if  the  substance 
be  affected,  then  a  weight  is  experienced ;  or  if  it  be  the 
peritoneal  coat  which  is  inflamed,  then  we  have  a 
greater  degree  of  pain  on  pressure,  and  a  pain  of  a 


INFLAMMATION  OF  THE  LIVER. 


233 


sharp  character.  These  are  all  nice  distinctions.  How- 
ever, there  is  no  doubt  that  the  pain  in  the  region  of 
the  liver  and  epigastrium  is  increased  by  pressure,  or  by 
inspiration  and  cough ;  and  there  is  no  doubt  the  pain 
is  still  greater,  when  the  peritoneal  coat  or  the  paren- 
chyma (the  texture  of  the  liver)  nearest  to  the  surface 
is  affected.  The  pain  frequently  extends  to  the  scapula 
(shoulder  blade),  goes  through  to  the  back,  and  not 
unfrequently  to  the  right  shoulder.  Some  contend  that 
the  pain  is  more  acute  when  the  patient  lies  upon  his 
right  side.  We  think  otherwise,  because  if  he  he  on 
the  left,  the  whole  mass  of  the  liver,  situated  as  it  is, 
will  of  necessity  pull  to  the  left,  and  all  the  parts  are 
put  upon  the  stretch.  Our  experience  teaches  us  that 
they  lie  best  upon  the  right  side.  We  frequently  have 
in  connection,  some  difficulty  in  the  respiration ;  other 
portions  of  the  body  sympathise;  we  have  a  dry  cough, 
with  tumefaction  detected  by  percussion ;  we  frequently 
have  jaundice,  sometimes  complete  to  its  full  extent. 

"A  deep  inspiration  increases  the  pain  by  the  descent 
of  the  diaphragm  on  the  liver ;  and,  when  the  convex 
surface  is  acutely  inflamed,  the  patient  often  suffers 
from  the  same  cause,  even  in  ordinary  respiration." 

Terminations. — This  acute  inflammation  frequently 
terminates  in  resolution,  and  sometimes  in  suppuration. 
The  latter  circumstance  is  very  common  in  this  country, 
however  rare  it  may  be  in  colder  latitudes ;  there  is 
sometimes  an  effusion  of  serum  in  the  substance  of  the 
liver ;  formation  of  pus,  and  consequently  of  abscesses, 
and  sometimes  both  circumstances  occur.  Large  quan- 
tities of  matter  are  sometimes  collected  in  this  way. 
Nature  frequently  assumes  various  ways  to  get  rid  of 
this  pus.    "Occasionally  an  adhesion  forms  between 


234 


INFLAMMATION  OF  THE  LIVER. 


the  two  parts  of  the  peritoneum,  the  loose  and  the  vis- 
ceral; and  the  matter  points  externally.  'Sometimes  an 
adhesion  takes  place  to  the  stomach ;  sometimes  to  the 
intestines;  and,  I  think,  the  matter  more  frequently 
finds  an  outlet  in  that  way  than  in  any  other.  Some- 
times nature  does  not  succeed  in  forming  adhesions,  and 
then  the  matter  is  poured  into  the  peritoneum.  Now 
and  then  an  occurrence  takes  place  less  favorable  than 
the  discharge  of  pus  into  the  stomach  and  intestines ; — 
adhesions  take  place  to  the  diaphragm,  and  the  matter 
is  discharged  through  the  air  passages.  We  have  cases 
on  record  in  which  the  pus  has  discharged  itself;  not  at 
the  front,  or  at  the  side,  but  at  the  back.  Cases  of  this 
description  have  been  mistaken  for  lumbar  abscess. 
Occasionally  the  matter  has  been  discharged  with  the 
urine ;  and  there  is  a  case  upon  record,  in  which  an 
abscess  emptied  itself  into  the  "  vena  cava,"  and  death 
was  the  consequence.  Sometimes  the  abscess  does  not 
discharge  itself  at  all,  but  there  it  remains ;  and  patients 
have  died  with  a  large  abscess  in  the  liver,  the  exist- 
ence of  which  was  not  known  before.  If  the  matter  be 
disposed  to  discharge  itself  externally,  it  is  evident 
enough ;  if  it  discharge  itself  into  the  stomach,  we  have 
vomiting  of  matter;  if  into  the  intestines,  we  have  a 
quantity  of  matter  in  the  stools ;  and  if  it  discharges 
itself  by  the  air  passages,  you  have  cough,  and  many  of 
the  other  signs  of  phthisis."  Hepatitis  in  its  acute  form 
is  very  common  in  most  all  of  the  fevers  of  this  climate, 
and  it  is  frequently  united  with  other  inflammations  of 
the  abdomen. 

Chronic  Hepatitis. — The  symptoms  of  chronic  hepa- 
titis are  not  very  well  marked.  We  frequently  have  all 
the  signs  of  dyspepsia;  and  with  the  exception  of  pain 


INFLAMMATION  OF  THE  LIVER. 


235 


on  pressure,  find  the  liver  apparently  almost  healthy. 
We  frequently  have,  connected  with  the  chronic  form, 
dysentery;  and  it  is  not  unfrequently  the  case,  that  you 
find  chronic  dysentery  and  chronic  hepatitis  at  the  same 
time.    This  is  common  in  this  climate. 

Treatment. — It  is  that  plain  and  simple  treatment  for 
inflammation,  commencing  with  aconite  to  lesson  arte- 
rial action,  regulated  in  quantity  by  circumstances,  fol- 
lowed by  local  depletion,  especially  with  the  cups,  (some 
prefer  leeches,)  warm  poultices  to  the  part,  and  purga- 
tives. We  find  mentioned  in  works  published  twenty 
or  thirty  years  ago,  and  in  many  works  at  the  present 
day,  that  mercury  ought  not  to  be  given  in  acute 
inflammation  of  the  liver.  Such  fallacies  have  passed 
away,  and  such  notions  are  only  retained  by  the  igno- 
rant, who  will  admit  of  no  discoveries  in  the  science  of 
medicine.  Our  own  opinion  is,  that  both  forms  require 
nearly  the  same  treatment,  for  whatever  is  good  in  the 
one  we  have  tested  was  beneficial  in  the  other  to  a  more 
or  less  degree.  Do  not  understand  us  as  being  the 
advocate  of  mercury,  although  at  the  same  time/  we  are 
not  so  much  prejudiced  in  favor  of  any  other  treatment, 
from  our  experience,  as  to  justify  us  in  saying  that  mer- 
cury, under  many  circumstances,  is  not  a  valuable  remedy. 
Because  an  article  has  been  badly  abused,  and  frequent 
injurious  results  have  followed  its  use  in  the  hands  of 
empirics,  it  is  no  reason  that  it  should  not  be  used.  I 
confess  that  I  think  the  podophyllin  a  good  substitute, 
in  general ;  but  I  have  found,  in  many  instances,  great 
relief  from  the  proper  administration  of  mercury. 

We  view  purgatives  as  particularly  useful  in  inflam- 
mation of  the  liver,  because  they  act  as  a  local  means  in 
preventing  blood,  to  a  great  extent,  from  going  into  the 


236 


INFLAMMATION  OF  THE  LIVER. 


vena  portea,  and  therefore  less  gets  into  the  liver.  Those 
purgatives  most  in  favor  with  us,  are  the  podophyllin 
and  mercurials,  and  the  cholagogues,  (medicines  that 
are  reputed  to  produce  a  flow  of  bile.)  Our  own  course 
has  been  to  give  podophyllin  or  our  bilious  pill,  (see  Jty.) 
in  small  portions,  frequently  repeated,  and  continue 
them  until  bilious  evacuations  are  produced;  if  these 
fail  we  have  generally  selected  calomel  for  this  purpose ; 
and  when  bilious  secretions  are  fairly  established,  we 
commence  the  use  of  podophyllin,  or  blue  mass  and  Tar- 
axicum  in  combination,  and  continue  according  to  cir- 
cumstances. We  have  frequently  derived  decided  advan- 
tage from  the  use  of  the  nitro-muriatic  acid,  used  both 
internally  and  externally.  We  have,  in  the  advanced 
stages  of  the  acute  variety,  as  also  in  the  chronic, 
resorted  to  counter-irritants  and  blisters  with  benefit. 
There  are  cases  in  which  setons  and  issues  would  be  of 
service.  In  the  chronic  variety  the  irritating  plaster  is 
a  valuable  remedy. 

Frequently  the  physician  is  apt  to  lose  sight  of  the 
disease,  if  there  is  a  temporary  improvement  in  the  gen- 
eral symptoms;  such  is  very  wrong,  as  the  disease  is 
frequently  deep  seated,  and  abscesses  may  form.  The 
greatest  care  is  requisite  upon  the  part  of  the 
physician  to  attend  to  the  diet  of  the  patient;  much 
depends  upon  the  patient  observing  strictly  the  injunc- 
tions of  his  attendant,  for  unless  he  do  so,  the  best  and 
most  salutary  treatment  will  fail  to  give  relief. 

We  have  frequently  in  our  practice  prescribed  the 
following  prescriptions,  and  we  can  speak  well  for 
them : 

fy.    Ex.  Colocynth  Comp.  9i. 
"   Scammoni,  9i. 


INFLAMMATION  OF  THE  LIVER. 


237 


Pulv.  aloes.  9i. 
Scil  marit. — (Squills.)  9i. 
Podophyllin,  vi.  grs.,  or  Blue  mass,  9i. 

Taraxicum, 

Mix  and  make  into  thirty  pills  5  take  two  every 
night,  or 

^.    Gamboge.  .  gss. 

Ex.  Eupatorium  perfoliatum,  Sss. 
Aloes,  Si- 
Castile  soap,  Sss. 
Ex.  Podophyllum, 
Ex.  Gentian. 

Lobelia  seeds,  pulv.  aa.  Sss. 

Capsicum,  3ii. 
Oil  cloves,  3i- 

Warm  the  extracts  until  they  are  quite  soft,  and  then 
add  the  powders.  Mix  thoroughly  and  add  the  oil; 
make  into  five  grain  pills. 

Give  one  night  and  morning,  as  an  alterative ;  they 
are  valuable  pills  in  bilious  fever,  in  doses  from  four  to 
six. 

Treatment  of  the  Suppurative  Stage. — "  As  to  the  sup- 
puration which  sometimes  occurs,  that  requires  to  be 
treated  on  common  principles.  If  the  abscess  point  to 
the  skin,  of  course  a  knife  may  be  applied,  and  the 
matter  let  out — -just  as  in  any  other  abscess,  only  that 
it  might  be  dangerous  to  let  out  a  great  quantity  at 
once.  It  should  be  done  gradually,  in  order  that  the 
part  may  slowly  contract.  If  the  discharge  takes  place 
inwardly,  through  the  lungs  or  the  intestines,  we  have 
only  to  lessen  the  irritation  by  narcotics,  as  in  other 
cases;  and  this  will  also  be  required  on  opening  the 
abscess." 


238 


INFLAMMATION  OF  THE  LIVER. 


There  are  a  great  variety  of  structural  diseases  of  the 
liver,  such  as  serous  cysts,  hydatids,  adipose  matter, 
tubercles,  malignant  tumours  and  formations — all  of 
which  are  interesting,  but  it  would  take  great  length  to 
do  the  subjects  justice. 

Nitric  acid  alternated  with  taraxicum,  is  a  favorite 
remedy  in  chronic  hepatitis,  and  deservingly  so. 

Leptandrhi.  —  The  resinous  principle  of  leptandra 
virginica,  is  a  valuable  agent  in  diseases  of  the  liver,  it 
is  one  of  the  most  efficacious  and  important  agents 
among  those  peculiar  to  eclectic  practice,  being  the 
only  known  medicine  that  efficiently  stimulates  and 
corrects  the  hepatic  secretions  and  functional  derange- 
ments of  the  liver,  without  debilitating  the  system  by 
copious  alvine  evacuations.  Its  effects  on  the  liver  are 
peculiar.  It  at  the  same  time  seems  to  act  as  a  tonic, 
restoring  the  tone  of  the  stomach  and  increasing  the 
strength  and  activity  of  digestion. 

The  dose  is  from  one-half  of  a  grain  to  five  or  six, 
every  three  or  four  hours,  according  to  the  action  or 
effect  desired. 

A  combination  which  is  valuable  in  affections  of  the 
liver,  is  one  part  of  podophyllin  and  ten  parts  leptan- 
drin,  triturated  with  ten  parts  of  sugar. 

Dr.  Newton  recommends  the  sanguinarin,  the  resinoid 
principle  of  bloodroot,  and  says  in  doses  from  one-six- 
teenth of  a  grain  to  one  grain.  In  combination  with 
leptandrin  and  podophyllin,  it  forms  a  medicine  which, 
for  safety  and  efficacy  in  the  treatment  of  hepatic  dis- 
eases, is  superior  to  any  other  remedies  yet  known  in 
medicine. 


JAUNDICE. 


239 


JAUNDICE. 

Jaundice  is  an  occasional  symptom  both  of  acute 
and  chronic  inflammation  of  the  liver.    In  general  it 
constitutes  of  itself  a  distinct  form  of  disease.    We  fre- 
quently find  that  the  coloring  matter  of  the  bile  has 
been  absorbed,  and  passed  into  the  circulation,  which 
accounts  for  the  yellow  tinge  the  skin,  eyes,  and  urine 
present.    One  of  the  most  peculiar  symptoms  of  the 
disease  is  the  yellow  color  we  find  in  the  conjunctiva, 
the  general  complaint  of  languor  and  drowsiness,  and  a 
disposition  to  scratch  the  surface ;  these  are  the  unmis- 
takeable  prominent  symptoms  of  jaundice.    In  general 
it  is  a  very  slight  disease,  arising  from  slight  causes,  and 
may  be  cured  by  very  simple  remedies.   In  that  peculiar 
form  of  "jaundice  in  which  the  yellow  verges  to  green," 
and  which  is  sometimes  called  green  jaundice,  recovery 
is  very  rare. 

Treatment. — Before  deciding  what  plan  of  treatment 
may  be  proper  in  any  case  of  jaundice,  you  should  most 
carefully  inquire  into  his  or  her  general  health,  and  the 
nature  and  duration  of  the  disease  from  which  the 
patient  has  recently  suffered ;  and  particular  attention 
should  be  paid  to  the  state  of  the  abdominal  viscera ; 
this  examination  will  indicate  the  remedies  which  will 
be  the  most  proper  to  use,  at  the  same  time  you 
must  look  well  to  the  condition  of  the  constitution. 
There  are  certainly  more  domestic  remedies  for  the  cure 
of  jaundice  than  for  almost  any  other  named  disease; 
almost  every  article  in  the  materia  medica,  and  that 
which  is  not  in  it  has  been  recommended  for  this  disease, 
even  as  low  as  goose  excrement,  so  says  Dr.  Wood. 
The  cure  of  jaundice  must  be  attempted  by  first  restor- 
ing the  interrupted  passage  of  the  bile  through  the  duct, 


240 


JAUNDICE. 


secondly  by  passing  it  off,  and  thirdly  to  combat  general 
symptoms.  Some  extol  emetics  very  highly,  we  question 
the  propriety  of  giving  them.  I  have  had  more  success 
with  jaundice  with  the  following  simple  recipe  than  I 
have  had  from  any  other  remedy. 

^.    Powdered  Rhei,  3  i. 
Castile  soap,       3  ss. 
Pulv.  aloes,        grs.  xv. 

Divide  into  twenty  pills.  Give  three  or  four  every 
night.  I  have  used  the  puccoon  or  blood  root  success- 
fully in  this  disease,  giving  from  forty  to  fifty  drops  three 
times  a  day. 

Hemlock,  in  combination  with  cinchonse  and  podo- 
phyllin,  I  have  no  doubt  will  prove  efficacious  if  used 
according  to  the  following : 

^.  Ex.  of  hemlock,  3  ss. 
Ex.  of  bark,  5  ii. 
Podophylline,     grs.  vi. 

Divide  into  four  pills,  and  give  two  to  four  daily. 

A  strong  infusion  of  the  bark  of  wild  cherry  in  cold 
water  is  a  valuable  remedy,  it  should  be  taken  in  wine- 
glassful  doses  every  three  or  four  hours  through  the  day. 

Hempseed,  boiled  in  milk,  is  highly  extolled,  may  be 
taken  in  any  quantity. 

When  you  have  reason  to  suspect  the  presence  of 
calculi,  obstructing  the  bile  ducts,  the  nitro-muriatic 
acids  will  be  found  of  great  service,  given  in  doses  of 
five  drops  three  times  a  day,  increasing  it  daily  until 
two  scruples  can  be  taken. 

In  those  attacks  of  jaundice  accompanied  with  pain 
and  vomiting,  opium  should  be  used  to  allay  the  irri- 


DISEASES  OF  THE  SPLEEN. 


241 


tability,  in  connection  with  the  warm  bath  and  emollient 
application  to  the  stomach. 

The  irritating  plaster  should  be  applied  over  the  liver. 

A  recipe  of  great  reputation  in  this  disease  is  the 
folio  wing,  and  I  can  safely  recommend  it,  viz  : 

ty.    Ext.  dandelion, 

Mandrake  and  bloodroot  hi  powder. 

Of  each  equal  parts.  Mix  together,  add  a  few  drops 
of  the  oil  of  spearmint,  and  divide  into  four  grain  pills. 
Dose,  two  or  three  pills  twice  a  day. 


SPLENITIS, 

DISEASES  OF  THE  SPLEEN. 

In  this  climate  I  know  of  no  diseases  more  common,  or 
none  that  are  more  neglected  than  diseases  of  the  spleen. 
Very  little  is  known  relative  to  the  functional  diseases  of 
the  spleen :  we  direct  our  attention  entirely  to  organic 
affections,  such  as  inflammation,  congestion,  hyper- 
trophy, enlargement  and  softening,  induration,  &c. 
there  are  various  prominent  signs  of  diseases  of  this 
organ,  such  as  an  enlargement,  which  is  generally  called 
"  ague  cake,"  but  which  is  technically  hypertrophy  (or 
enlargement)  of  the  spleen.  We  have  various  other 
symptoms  of  splenic  disease,  such  as  pain,  oppressed 
respiration,  bending  of  the  body  to  the  affected  side, 
inability  to  lie  on  the  right  side,  tendency  to  dropsy  and 
dysentery,  &c.  We  frequently  find  an  enlargement  of 
the  spleen  as  the  result  of  intermittent  fever,  we  also 
16 


242 


DISEASES  OF  THE  SPLEEN. 


have  hypertrophy  as  the  result  of  deranged  menstrual 
functions.  And  we  find  this  disease  more  frequently  in 
damp  and  marshy  situations  than  elsewhere. 

"  Most  patients  with  an  enlargement  of  the  spleen 
are  affected  with  a  short  and  imperfect  respiration ;  the 
general  appearance  of  the  patient  evincing  that  decar- 
bonization,  (the  transformation  of  venous  blood  and  chyle 
into  arterial  blood  by  respiration)  if  the  blood  is  not 
sufficiently  decarbonized,  any  attempt  to  take  active 
exercise  excites  panting  and  distress  at  the  chest.. 
Among  the  usual  attendants  on  vascular  enlargement 
of  the  spleen  we  may  observe  impaired  appetite,  difficult 
digestion,  and  imperfect  assimilation  of  food.  In  the 
latter  stages  of  the  disease  oedemea  (swelling)  of  the  feet 
is  present,  and  sometimes  the  face  and  eyelids  are 
swollen.  The  majority  of  protracted  cases  that  termi- 
nate fatally  suffer  from  dysentery,  or  dropsy  of  the  belly ; 
and  when  the  abdomen  is  much  distended  from  this 
latter  cause,  the  superficial  veins  in  the  side  of  the  chest 
and  belly  appear  large  and  numerous,  showing  the  ex- 
tent and  degree  to  which  the  circulation  in  the  internal 
organs  becomes  ultimately  obstructed." 

Diseases  of  the  spleen  often  occur  in  conjunction  with 
intermittent  and  remittent  fevers,  dysentery,  and  some- 
times diseases  of  the  liver ;  the  tumefaction  of  the  spleen 
frequently  comes  on  very  suddenly,  almost  without  any 
premonitory  symptoms,  in  the  course  of  these  fqvers, 
and  in  a  little  time  the  enlargement  is  considerable ;  it 
varies  considerably,  but  it  is  nothing  unusual  in  this 
climate,  to  see  the  spleen  extending  downwards,  even 
with  the  umbilicus,  and  laterally,  as  far  as  half  way 
between  the  cartilages  of  the  ribs  and  the  navel.   I  have 


DISEASES  OF  THE  SPLEEX. 


243 


frequently  seen  cases  filling  up  the  larger  portion  of  the 
abdomen,  even  to  the  iliac  region. 

Enlargement  of  the  spleen  sometimes  appears  as  an 
idiopathic  disease  in  children,  and  in  persons  of  delicate 
and  feeble  constitutions ;  and  is  produced  by  the  com- 
bined influence  of  a  damp  climate,  variable  temperature, 
such  as  we  have  in  Texas,  want  of  exercise,  unsuitable 
clothing,  and  insufficient  nourishment.  The  major  part 
of  the  cases  of  vascular  engorgement  of  the  spleen  in 
Texas,  follow  intermittent  and  remittent  fevers ;  it  is 
also  the  result  of  other  debilitating  diseases,  but  more 
especial!)'  after  protracted  remittent  and  intermittent, 
which  we  find  here  occasionally  at  all  seasons. 

Induration  and  Softening  of  the  Spleen. — Sometimes, 
without  any  enlargement,  we  find  the  spleen  exceedingly 
hard — cutting  exactly  like  liver ;  and  sometimes,  on  the 
other  hand,  it  will  become  exceedingly  soft.  Very  often 
where,  during  life,  we  could  discover  no  particular  ail- 
ment referable  to  the  abdomen,  the  spleen  is  soft.  If  it 
be  not  preternaturally  hardened,  we  may,  by  working 
it  up  in  our  hand,  bring  it  to  the  consistence  of  currant 
jam;  but  in  various  diseases  we  find  that  the  spleen,  on 
being  cut,  is  soft. 

Congestion  of  the  Spleen. — The  spleen  suffers  a  great 
accumulation  of  blood,  when  there  is  any  obstruction  in 
the  organs  of  respiration.  It  is  supposed  by  some,  that 
the  size  of  the  spleen  may  depend  very  much  upon  the 
mode  in  which  patients  die.  If  they  die  after  long 
continued  dyspnoea,  (difficulty  of  breathing.)  we  may 
find  the  spleen  large,  although  during  life  it  was  not  so 
enlarged,  or  at  least  it  had  not  the  appearance. 

Treatment. — The  treatment  in  the  acute  form,  is  simi- 
lar to  that  of  other  inflammatory  affections.    We  have 


244 


DISEASES  OF  THE  SPLEEN. 


a  high  regard  for  purging,  while  there  are  many  others 
that  disapprove  of  it.  Some  hold  mercury  in  high 
esteem  in  diseases  of  this  character,  whilst  Ave  unhesi- 
tatingly condemn  it  as  pernicious.  A  variety  of  reme- 
dies have  been  highly  extolled,  such  as  cincjiona  and 
iodine.  I  have  great  faith  in  nitrate  of  potash.  Com- 
pression and  hygienic  means  are  certainly  of  great  ser- 
vice in  splenic  affections. 

Our  treatment  in  the  early  stage  of  enlargement  of 
the  spleen,  must  depend  considerably  on  the  amount  of 
fever  present.  We  would  also  be  guided  by  the  degree 
of  hyperemia  (congestion,)  and  the  general  condition  of 
the  patient.  "  But  mercury,"  says  the  celebrated  Twin- 
ing, "must  never  be  used,  with  a  view  to  cure  the  dis- 
ease of  the  spleen."  We  generally,  when  we  find  vas- 
cular engorgement  of  the  organ,  commence  a  course  of 
purgative  medicine,  combined  with  some  preparation  of 
iron;  we  eup  the  spleen  actively  for  two  or  three  days, 
and  then  generally  apply  a  sinapism ;  the  formula  for 
the  purgative  which  we  generally  use,  is  Twining's 
Spleen  Mixture,  which  is  : 

3^.    Pulv.  Jalap, 

"  Rhei, 

"  Calumbas, 

"  Zinziberis, 
Potassse  Supertartratis,  aa.  5i-  (Cream  of  Tartar.) 
Ferri  Sulphatis,  9ss.  (Sulph.  Iron.) 

Tinct.  Senna?,  oiv. 
Mint  Water,  Sx.  Mix. 

The  dose  is  one  ounce  and  a  half  for  an  adult,  at  6, 
A.  M.,  and  repeated  at  11,  A.  M.,  daily. 

For  children,  the  doses  are  regulated  so  as  to  produce 


DISEASES  OF  THE  SPLEEN. 


245 


not  less  than  three,  and  not  more  than  four  stools  daily. 
This  medicine  acts  as  a  purgative  tonic  and  diuretic. 
The  purgative  properties  of  the  two  first  articles  in  this 
prescription,  will  be  assisted  by  the  cream  of  tartar, 
while  that  medicine  with  the  jalap,  generally  acts  on 
the  kidneys;  the  principal  effects  of  the  other  ingre- 
dients may  be  referred  to  their  tonic  and  astringent 
properties.  The  cure  of  the  enlarged  spleen  may  pro- 
bably be  in  some  measure  owing  to  the  effects  produced 
on  the  circulation  in  that  organ,  by  the  frequent  appli- 
cation of  a  powerful  astringent  to  its  immediate  vicinity. 
I  of  late  use  a  smaller  quantity  of  sulph.  ferri  in  ordi- 
nary cases,  and  sometimes  add  gi.  of  pulv.  scammon. 
comp.  to  the  above  mixture,  for  patients  who  are  very 
costive,  and  require  stronger  purgatives.  On  the  other 
hand,  in  very  delicate  and  emaciated  subjects,  who  are 
easily  purged,  it  is  requisite  to  substitute  compound  tinc- 
ture of  cardamons  for  the  tincture  of  senna;  and  if 
there  be  any  disposition  to  paroxysms  of  intermittent 
fever,  I  add  to  the  mixture  the  same  quantity  of  qui- 
nine as  it  contains  of  sulphate  of  iron. 

When  the  disease  is  obstinate,  there  is  an  advantage 
in  changing  the  prescription  occasionally;  and  after  the 
above  has  been  used  for  ten  days,  the  patient,  if  an 
adult,  is  directed  to  take  eight  grains  of  compound 
extract  of  colocynth,  with  two  grains  of  gamboge,  in 
pills,  at  bed-time,  and  twenty  drops  of  tinct.  ferri  mu- 
riat.  in  a  wine-glass  of  water,  with  5i.  of  tinct.  gentian 
comp.  at  7,  and  repeated  at  11,  A.  M.  These  medi- 
cines are  to  be  continued  for  five  days,  and  then,  after 
taking  the  spleen  mixture  for  ten  days  more,  the  patient 
is  ordered  to  take  5ss.  of  the  powder  of  black  myro- 
balan,  with  9ss.  black  salt  every  morning;  and  eight 


246 


DISEASES  OF  THE  SPLEEN. 


grains  of  compound  extract  of  colocynth,  with  two 
grains  of  sulphate  of  iron,  and  ten  grs.  of  aloes,  in  pills, 
at  bed-time.  Thus,  for  two-thirds  of  the  time  the 
patient  is  taking  the  spleen  mixture,  with  the  occasional 
change  to  another  medicine  for  a  short  interval,  whereby 
the  efficacy  of  the  principal  remedy  is  not  weakened  by 
its  habitual  use.  It  cannot  be  of  importance  to  adhere 
invariably  to  a  precise  number  of  days  in  using  each 
prescription,  but  an  occasional  change  is  requisite ;  and, 
at  any  time  during  the  treatment,  if  the  patient  becomes 
feverish,  the  above  medicines  are  omitted,  a  dose  or  two 
of  jalap  is  given,  and  leeches  or  venesection  employed. 

In  the  treatment  of  a  diseased  patient  for  spleen, 
careful  attention  must  be  paid  to  his  diet ;  in  chronic 
cases  we  must  have  patience,  and  it  is  not  required  to 
give  the  spleen  mixture  so  often. 

"  Water  which  has  been  used  for  cooling  heated  iron 
at  a  blacksmith's  forge,  has  been  recommended  as  an 
auxiliary  to  other  remedies  employed  in  the  cure  of 
enlarged  spleen." 

We  have  determined,  as  this  is  a  disease  of  so  com- 
mon an  occurrence,  to  give  from  our  practice  a  few 
cases,  to  illustrate  upon  general  principles,  the  treat- 
ment of  this  disease.  Mr.  G.,  aged  thirty,  a  farmer, 
had  quotidian  fever  of  four  weeks  standing,  with  quite 
an  enlarged  spleen.  Massie's  tonic  pill,  was  ordered 
in  the  first  place,  to  eradicate  the  chill,  which  it  did 
successfully.  I  then  directed  my  remedies  to  the  spleen. 
We  ordered  six  cups  to  be  applied,  and  prescribed — 

Nitrate  potash,  grs.  10 

Sulph.  quinine,  "  2£ 

to  be  given  every  three  hours. 


DISEASES  OF  THE  SPLEEN. 


247 


Ordered  two  cups ;  the  former  prescription  had  been 
beneficial,  but  for  the  purpose  of  producing  a  healthy 
tone,  we  ordered  peruvian  bark,  3ss. ;  cream  of  tartar, 
same  amount,  every  four  hours.  Another  cupping  was 
ordered,  and  in  a  few  days,  during  which  time  he  took 
the  spleen  mixture,  he  was  completely  relieved. 

Second  Case. — Mrs.  J.  consulted  me  on  the  4th  Sept., 
1845;  she  was  very  pale,  and  considerably  emaciated; 
her  feet  were  slightly  oedematous,  tongue  white ;  pulse 
91  and  weak.  The  spleen  was  very  much  enlarged, 
and  very  painful  on  pressure.  She  was  quite  costive, 
complained  of  headache,  had  little  or  no  appetite,  was 
becoming  progressively  weaker  daily.  We  ordered  four 
cups,  and  the  following  prescription : 

^.    Pulv.  cinchonae,  Si. 


This  was  mixed  intimately  together,  and  a  tea-spoonful 
given  before  each  meal,  for  four  days. 

Sept.  9th. — Feels  much  better,  but  very  weak;  spleen 
not  decreased ;  two  cups  were  ordered  and  the  spleen 
mixture,  with  the  addition  of  a  scruple  of  quinine. 

Sept.  lOtJi. — Has  had  chilly  sensations,  the  mixture 
produced  two  stools ;  took  another  dose  this  morning, 
discharges  watery. 

Sept.  11th. — No  sensations  of  chill  to-day,  and  she 
thinks  herself  better ;  the  morbid  sensibility  of  the 
spleen  is  much  reduced,  and  the  tumefaction  is  smaller; 
ordered  the  cups  and  same  mixture,  so  as  to  produce 
about  two  actions  daily. 

•Sept  17th. — The  above  mixture  was  continued  from 


Cream  Tartar, 
Nitrate  Potash, 


Si- 
Sii. 


248 


DISEASES  OF  THE  SPLEEN. 


day  to  day,  with  decided  benefit.  The  tumefaction  of 
the  spleen  has  entirely  subsided,  and  her  health  very 
much  improved.  Ordered 

1^.    Pil.  Rhei.  comp. 

Ex.  comp.  colocynth,  aa.  5ss. 
Olei  mentha,  drops  v. 

Make  into  ten  pillsj  two  to  be  taken  at  bed  time. 

Also, 

I$>.    Sulph.  quinine,  5ss. 

Aquae  mentha,  Sx. 

Sulph.  acid,  3ss. 

Mix,  and  give  two  table-spoonfuls  at  ten  o'clock,  fore- 
noon, every  day. 

Sept.  2\st — No  complaint,  except  debility;  bowels 
rather  too  free.  This  patient  took  regularly  the  spleen 
mixture,  and  recovered  entirely.  We  generally,  in 
chronic  cases,  pursue  the  same  course,  with  the  addi- 
tion that  we  make  a  plaster,  which  we  enjoin  to  be 
worn  constantly,  from  the  following  ingredients,  viz : 

Take  of  Sang.  can. — (Bloodroot). 

Podophyllum. — (Mandrake) . 
Arum  triphyllum. — (Indian  turnip). 
Phytollaccse  decandriae. — (Pokeroot,)  aa.  §21. 
Tar,    1  quart. 
Rosin,  Siv. 

V. 

Boil  the  tar  until  its  water  is  evaporated ;  add  the 
rosin,  and  let  it  melt;  cool  it  a  little,  and  add  the 
powders  while  it  is  nearly  boiling  hot,  and  stir  briskly 
until  it  becomes  stiff.    It  is  to  be  spread  on  thin,  soft 


DISEASES  OF  THE  SPLEEN. 


249 


leather,  and  applied  fresh  every  day,  until  it  produces 
considerable  irritation.  A  favorite  prescription  of  Prof. 
Drake,  was  to  take 

Peruvian  bark,  Si- 
Cream  of  tartar,  Si- 
Nit.  potash,  (nitre),  3ii. 
Mix  and  triturate  intimately  together,  and  then  take 
a  tea-spoonful  bafore  each  meal. 

In  some  cases,  I  have  given  the  following  recipe  with 
decided  advantage,  in  connection  with  Miller's  ointr 
ment.    I  give 

Hydriod  potassae,  9ii. 
Iodine,  9i. 
Distilled  water,  5i. 
Mix  intimately,  and  give  twenty  drops  three  times 
a-day.    You  can  increase  the  dose  one  drop  at  a  time, 
and  continue  it  in  chronic  cases.    Miller's  plaster  is 

Hydriod  potassae,  Si. 
Suet,  Si. 
Mix,  warm  and  spread  it,  and  apply  on  the  spleen. 

A  prescription  which  I  have  never  used,  but  which 
my  friends,  Doctors  Rogers  and  Irion,  (and,  I  am  in- 
formed, it  is  quite  a  favourite  with  Dr.  Arnold  of  Mont- 
gomery, a  gentleman  of  distinction  in  his  profession,) 
highly  extol  in  this  disease,  is  the  following : 

Iodide  of  potassium,  grs.  3. 

Red  iodide  of  mercury,  grs.  41. 

Distilled  water,  fl^i. 

Dissolve  first  the  iodide  of  potassium,  and  then  the 
mercurial  salt  in  the  water.  The  dose  is  from  three  to 
five  drops,  three  times  a-day,  much  diluted. 


250 


WINTER  EPIDEMICS. 


A  highly  popular  mode  of  treating  diseases  of  the 
spleen,  especially  when  they  are  hypertrophied,  is  by 
iodine  and  digitalis.  I  have  tried  it  in  some  few  cases, 
and  am  satisfied  it  is  a  valuable  auxiliary  hi  the  treat- 
ment of  this  disease. 

Dr.  Ruchenmuster  states,  that  impure  and  non-crys- 
talized  gentianine,  may  be  used  instead  of  sulphate  of 
quinine.  He  contends, — 1st.  That  gentianine  acts  as 
efficaciously  on  the  spleen  as  quinine.  2d.  That  fifteen 
or  thirty  grains,  twice  a-day,  are  sufficient.  3d.  That 
gentianine  is  certainly  the  most  valuable  succedaneum 
to  quinine,  which  has  ever  been  used. 

The  silpkium  perfoliatum  or  ragged  cup,  is  one  of  the 
best  eclectic  remedies  for  the  removal  of  ague  cake  or 
enlarged  spleen,  it  is  both  tonic,  diaphoretic  and  altera- 
tive. A  strong  infusion  of  the  root,  made  by  long 
steeping,  or  an  extract,  is  said  to  be  best  for  use. 


DISEASES  OF  THE  PULMONARY  TISSUE 
AND  PLEURA, 

WINTER  EPIDEMICS. 

In  the  former  pages  we  have  endeavored  to  point  out 
the  cause  of  autumnal  fevers,  their  effects  on  the  general 
system,  and  the  best  mode  of  obviating  them.  We  pro- 
pose to  investigate  the  winter  epidemics,  and  to  make  a 
few  general  observations  on  the  treatment,  and  espe- 
cially upon  the  epidemic  that  raged  through  every  sec- 
tion of  the  country  in  the  latter  part  of  '46  and  begin- 
ning of  the  year  '47,  termed  winter  fever,  but  confirmed 
pneumonia. 


WINTER  EPIDEMICS. 


251 


In  any  section  of  country  in  which  miasma  is  found, 
the  population,  to  a  very  great  extent,  is  exposed  more 
or  less  to  its  influence,  and  it  is  obvious  the  effects 
appear  under  various  stages.  It  is  a  question  with  me, 
if  any  escape  without  a  considerable  change  in  the 
blood;  it  generally  becomes  darker;  some  lose  their 
appetite  entire,  others  have  an  abhorrence  for  food,  and 
others  again  have  a  very  irritable  stomach ;  many  per- 
sons have  foul  tongues — some  actually  have  chilly  sen- 
sations, and  experience  considerable  pain  in  various 
parts  of  the  body.  And  all  these  symptoms  will  be 
found  in  individuals  who  feel  indisposed,  but  are  yet 
nevertheless  capable  of  attending  to  their  usual  avoca- 
tions. 

These  general,  but  morbid  symptoms  in  various  de- 
grees, continue  most  generally  to  affect  the  settlers 
throughout  the  whole  season.  Frequently  numbers 
become  diseased,  and  at  the  approach  of  cold  weather, 
many  are  still  lingering  on  the  verge  of  an  attack.  It 
is  a  self-evident  proposition,  that  when  winter  appears, 
miasmata  ceases,  that  is,  its  production,  and  the  extra- 
ordinary violent  and  sudden  winds  that  we  experience 
in  this  climate,  have  a  great  tendency  to  disperse  all 
that  remain  even  in  low  marshy  places.  Therefore,  the 
cause  ceasing  to  operate,  the  effects  gradually  subside, 
though  not  immediately;  "for  we  meet,  in  every  period 
of  cold  weather,  with  cases  in  which  green  or  black  dis- 
charges from  the  stomach  and  bowels,  and  other  effects 
of  miasmata  appear."  We  are  satisfied  there  are  gentle- 
men of  fine  attainments  in  their  profession,  who  find 
within  themselves  a  very  great  difficulty  in  fully  admit- 
ting the  dependence  of  those  diseases  on  miasmata. 
Their  doubts  arise,  and  with  some  degree  of  plausibility, 


252 


WINTER  EPIDEMICS. 


too,  from  the  fact,  that  cases  of  autumnal  fever  appear 
at  a  considerable  distance  from  sources  of  miasmata. 
"We  conceive  at  least  one  point  on  this  subject  as  set- 
tied,  tluit  every  man's  experience  has  brought  him  to 
the  conclusion,  that  autumnal  fever  is  certain  to  prevail 
in  the  heat  of  summer  along  the  borders  of  marshy 
grounds,  not  covered  with  water  so  as  to  prevent  the 
full  action  of  the  sun.  Wherever  such  a  spot  is  formed 
by  the  regulation  of  streets  in  a  town,  by  the  building 
of  a  mill-dam,  or  in  any  other  way,  provided  the  Water 
does  not  cover  the  surface  from  the  full  action  of  the 
sun,  there,  in  hot  weather,  autumnal  fever  prevails. 
Whenever  this  marshy  state  is  done  away  by  draining, 
by  filling  with  earth,  by  covering  with  water,  or  by 
excessive  drought  in  the  heat  of  summer,  the  fever 
ceases.  The  presence  of  both  heat  and  moisture  is 
shown  to  be  necessary  by  the  failure  of  the  fever  to 
appear  in  cool  countries  until  hot  weather,  and  by  its 
disappearance  as  soon  as  the  country  becomes  dry  after 
the  rains  or  inundations  cease. 

"  It  cannot  be  admitted  as  an  objection  to  this  known 
truth,  that  cases  of  fever  occur  at  a  distance  from 
marshes,  or  the  borders  of  streams.  Whatever  these 
may  be  attributed  to,  it  remains  absolutely  certain  that, 
wherever  heat  and  moisture  co-operate  on  vegetable 
matter,  there  fevers  arise."  Here  is  a  position  that  we 
hold  as  certain : — the  occurrence  of  cases  of  fevers  in 
such  situations,  that  it  is  asserted  this  cause  cannot  be 
■present,  is  no  proof  that  the  latter  does  not  produce 
those  cases  which  occur  where  it  is  present.  When, 
therefore,  winter  sets  in,  we  have  another,  although  a 
remote  cause  of  fever  in  progress,  and  in  districts  in 
which  miasmata  abound,  the  settler  is,  at  the  same 


WINTER  EPIDEMICS. 


253 


time,  under  the  influence  of  both  of  these  causes. 
During  the  autumnal  season,  fever  is  frequently  induced 
in  subjects  under  the  influence  of  miasmata,  by  an 
undue  exposure  to  the  rigors  of  the  season ;  sometimes 
from  want  of  care  during  sleep  in  cold  nights,  and  very 
frequently,  at  this  season  of  the  year,  in  neglecting  to 
change  wet  clothes.  It  is,  therefore,  quite  evident,  that 
when  a  community  is  under  the  peculiar  influence  of 
miasmata,  the  co-operation  of  cold  will  most  certainly 
produce  a  continuance  of  the  ejjidemic  through  the 
winter  months. 

Cold,  therefore,  in  addition  to  its  influence  on  the 
general  system,  whereby  it  assists  in  producing  fever, 
has  a  local  operation  upon  the  part  to  which  it  is  imme- 
diately applied.  It  is  not  only  known,  but  observed  as 
a  common  fact,  that  whenever  cold  is  applied  to  any 
external  part  of  the  body,  it  produces  considerable  red- 
ness and  swelling,  which  frequently  terminates  in  severe 
inflammation. 

"  In  the  like  manner,  when  applied  to  the  fauces  and 
to  the  lungs,  it  often  produces  inflammation  in  those 
parts.  Fevers,  accompanied  by  these  local  affections, 
are  distinguished  by  appropriate  names.  Unfortunately 
amongst  the  citizens  they  view  it  all  alike,  and  fre- 
quently, by  tampering,  hazard  the  lives  of  individuals 
by  simple  remedies,  when  there  are  but  few  exceptions 
that  do  not  require  the  most  active  course.  Fever,  with 
such  local  affection  of  the  lungs  or  pleura,  (the  mem- 
brane covering  the  lungs,)  is  called  pmumatiia,  or 
pleurisy.  When  cold  produces  the  fever,  with  such 
local  affections  or  pleurises,  in  persons  who  are  under 
the  influence  of  miasmata,  bilious  symptoms  are  the 
effects  of  miasmata,  and  the  disease  is  called  bilious 


254 


ACUTE  PLEURITIS. 


pleurisy.  Bilious  pleurisy,  which  occurs  in  winter,  is 
therefore  the  effect  of  the  combined  influences  of  mias- 
mata and  cold." 

These  winter  fevers  have  become  very  prevalent 
during  the  fall  and  winter  months  in  our  climate,  and 
unfortunately,  so  far  have  been  very  fatal.  I  am  of 
opinion  that  the  fatality  has  been  caused,  from  the  insi- 
dious manner  of  these  attacks,  by  inducing  persons  to 
delay  in  sending  for  medical  aid.  They  have  prevailed, 
heretofore,  on  the  Brazos  and  Navasoto  to  a  great  extent. 
They  are  commonly  attended  by  symptoms  of  a  partial 
inflammation,  whence  they  are  denominated  pleurisies 
of  the  eye,  or  of  the  head ;  but  most  frequently  they 
affect  the  side.  In  those  several  forms  the}'  are  equally 
dangerous. 

We  shall  now  proceed  to  consider  these  diseases ;  -and, 
in  the  first  place,  we  will  attempt  to  elucidate  that 
which  is  most  common,  acute  pleuritis. 

ACUTE  PLEUEITIS. 

General  Symptoms.  —  The  pleura,  (the  membrane 
covering  the  lungs,)  is  a  serous  membrane,  and  there- 
fore in  most  cases,  at  the  onset,  we  have  a  firm  hard 
pulse — not  invariably,  but  generally.  Then  as  to  the 
local  symptoms,  they  begin  commonly  like  an  ague 
fit,  with  shivering  and  shaking,  flying  pains  all  over  the 
body,  sometimes  bilious  vomitings  and  purgings;  most 
patients  are  seized  with  stitches  in  their  sides,  striking 
upwards  to  the  clavicle  and  shoulder  blade ;  in  addition 
to  these,  some  have  severe  pain  through  the  thorax, 
(chest,)  difficulty  of  breathing  sometimes  extreme,  and 
cough  attended  by  expectoration,  and  sometimes  not ; 
when  there  is  no  pain  in  any  part  of  the  thorax,  but  a 


ACUTE  PLEURITIS. 


255 


severe  one  in  the  head,  it  is  then  frequently  termed 
pleurisy  of  the  head — the  respiration  is  very  hurried, 
because  the  patient  is  unable  to  make  a  deep  inspira- 
tion, and  to  make  up  for  this,  he  breathes  more  quickly. 
The  pain  is  greatly  increased  by  coughing,  and  some- 
times by  speaking.  In  general,  there  is  no  difficulty  in 
making  out  the  nature  of  the  disease  sufficiently  with- 
out resorting  to  percussion  or  auscultation.  This  affec- 
tion is  very  plainly  marked — more  so  than  any  one  of 
which  I  am  acquainted ;  we  sometimes  have  an  enlarge- 
ment of  the  affected  side,  from  an  effused  fluid,  we  then 
have  £  severe  pain  in  the  region  of  the  nipple ;  it  is 
generally  acute  and  lancimating,  and  is  greater  as  the 
effusion  is  more  extensive ;  in  the  milder  attacks,  the 
cough  is  generally  insignificant ;  the  patient  usually 
rests  upon  the  healthy  side.  In  this  disease  we  have 
many  symptoms  that  are  common  with  other  inflamma- 
tions of  the  serous  tissues.  The  character  of  the  fever, 
after  the  first  day,  is  generally  persistent,  with  a  quick, 
tense  and  small  pulse.  The  seat  of  the  pain  will  some- 
times vary  in  the  course  of  the  disease.  It  has  been 
known  to  cease  in  one  side,  and  be  felt  by  the  patient 
in  the  other ;  and  it  is  said,  that  now  and  then,  the  pain 
is  not  felt  in  the  part  which  is  found  inflamed  after 
death.  It  is  said  that  sometimes  no  pain  has  been  felt 
at  all,  and  the  physician  has  been  surprised  to  find,  on 
examining  after  death,  violent  marks  of  inflammation. 
As  we  remarked,  the  patient  generally  lies  on  the  oppo- 
site side,  but  sometimes  he  can  lie  only  on  the  affected 
side.  We  have  thought  it  was  not  necessary  for  us  to 
give  the  auscultatory  signs — as  our  book  is  intended  for 
all  classes,  there  are  able  works  written  especially  upon 
this  branch  of  the  science,  which  medical  men  would 


256  ACUTE  PLEURITIS. 

refer  to — and  to  give  the  sounds  for  the  mass  of  general 
readers,  Ave  deem  it  useless,  as  they  could  neither  under- 
stand them,  nor  infer  our  meaning,  from  the  fact  that 
but  few  know  any  thing  of  the  anatomy  of  the  parts. 

Treatment. — Upon  the  treatment,  it  seems  to  me  it 
will  be  useless  to  dwell,  as  it  requires,  for  the  most  part, 
an  antiphlogistic  course.  It  is  treated  as  you  would 
treat  any  common  inflammation — aconite  to  reduce  the 
arterial  action ;  if  it  fails,  you  may  have  to  resort  to  the 
lancet.  Podophyllin  and  low  diet  will,  in  almost  all 
instances,  arrest  it. 

With  regard  to  those  cases  in  which  there  are  ca- 
tarrhal or  pneumonic  symptoms,  it  is  necessary,  in  addi- 
tion to  the  treatment  called  for  by  the  bilious  symptoms, 
to  make  use  of  remedies  suited  to.  remove  the  inflamma- 
tion of  the  lungs.  These  are  chiefly  cupping  and  blister- 
ing. The  acute  pain  in  the  side  or  breast,  which  most 
frequently  occurs,  together  with  the  cough  and  the  great 
difficulty  of  breathing,  seem  to  call  for  cupping  freely, 
and  the  great  object  of  the  physician  should  be  to  arrest 
and  destroy,  if  possible,  the  inflammation  at  its  onset. 
The  most  successful  mode  to  do  this,  in  severe  cases,  is 
to  resort  to  the  aconite  and  cups  freely,  pushing  them  to 
the  extent  of  removing  all  pain  upon  a  full  inspiration, 
or  at  least  until  all  hardness  of  the  pulse  ceases.  This 
should  generally  be  followed,  if  pain  is  complained  of, 
by  a  large  warm  poultice,  made  from  hops,  or  the  inner 
bark  of  the  red  oak,  and  covered  with  flannel,  or  an 
application  of  warm  dry  napkins  should  be  applied. 
Unfortunately  for  the  patient,  blisters  are  too  apt  to  be 
applied,  whilst  the  inflammation  is  at  its  highest,  evi- 
dently doing  considerable  harm ;  they  are  serviceable,  if 
applied  after  the  active  inflammatory  symptoms  have 


ACUTE  PLEURITIS. 


257 


been  checked — they  then  promote  absorption,  and  are 
beneficial  in  the  advanced  stages. 

These  desultory  remedies  should  be  repeated,  if,  within 
a  few  hours,  the  pain  returns  or  the  pulse  resume  its 
former  hardness.  Local  depletents  should  be  used,  and 
should  be  administered  when  the  pain  is  most  acute. 
My  own  practice  is  to  give  a  strong  infusion  of  pleurisy 
root,  half  ounce  to  the  pint  of  boiling  water;  in  a  tumbler 
full  of  this  you  may  give  twenty  drops  of  digitalis  or  two 
grains  of  ipecac,  every  three  or  four  hours,  to  produce 
diaphoresis  in  the  commencement.  I  then  give  podo- 
phyllin  or  calomel  in  combination  with  Dover's  powders 
or  ipecaci.,  and  it  is  sometimes  necessary  to  give  nitre, 
*  digitalis,  squills  and  colchicum.  However,  generally 
podophyllin  in  ss.  gr.  doses,  or  calomel  in  five  grain  doses, 
with  the  same  amount  of  Dover's  powders  every  three 
or  four  hours  will  give  relief.  If  they  should  not  operate 
and  arouse  the  secretions  fully,  I  then  give  an  active 
draught  of  salts  and  senna,  afterwards,  if  much  arterial 
excitement,  I  resort  to  the  squills  and  digitalis,  or  you 
can  add  digitalis  or  colchicum  in  a  saline  mixture  with 
an  excess  of  alkali,  to  determine  to  the  kidneys  and 
skin,  and  to  lower  the  inflammatory  condition  of  the  blood. 

"  After  the  decline  of  fever,  should  effusion  remain, 
attempts  may  be  made  to  promote  the  absorption  of  the 
liquid  by  squills  in  connection  with  calomel."  This 
may  be  a  valuable  combination  under  the  peculiar  cir- 
cumstances that  sometimes  exist,  but  in  this  sta^e 
generally  you  will  find  the  following  recipe  of  decided 
advantage  :       fy.    Lobelia  seeds, 

•  Ictodes,  (skunk  cabbage,) 

#  Sang,  asclepias,  (blood  root,  pleurisy 
root,)  aa.  3  i. 

17 


258 


ACUTE  PLEURITIS. 


Assarum  can.  %  h  (wild  ginger,) 
Water  and  alcohol,  aa.  1  qt. 

Make  a  'tincture,  and  mix  with  half  the  quantity  of 
simple  syrup ;  this  may  be  given  in  tea-spoonful  doses 
every  two  or  three  hours. 

A  favorite  prescription,  I  think  of  Dr.  Buchanan  or 
Beach,  may  be  alternated  with  the  above,  it  is  as  follows, 
take 

Ify.  Elecampane, 

Asclepias  aa.  1  lb.  (pleurisy  root,) 
Macro tys,  (black  cohosh,) 
Comfrey, 

Eupatorium  perfol,  (thoroughwort  or  boneset,) 

Hoarhound, 

Sycamore  bark, 

Iceland  moss,  aa.  I  lb. 

(Blood  root,)  Sanguinaria  I  lb. 
Make  three  and  a  half  gallons  of  syrup,  without 
spirits,  and  add  the  saturated  tincture  of  ictodes  foet., 
(skunk  cabbage  root,)  assarum  cand,  aa.  1  pint,  (colt's- 
foot,)  and  the  tinctures  of  lobelia  and  cypriped.  pubesc. 
aa.  one-half  pint,  (lady  slipper.)  Dose,  one  to  two 
table-spoonfuls  every  two  or  three  hours. 

In  conclusion,  I  beg  leave  to  recommend  quinine  in 
this  affection,  and  those  who  will  have  the  boldness  to 
test  it  will  not  be  disappointed  if  they  will-  administer  it 
for  its  sedative  influence;  I  have  given  it  time  and 
again,  in  combination  with  ipecac,  when  the  skin  was 
hot  and  dry,  pulse  full  and  tense,  tongue  parched.  And 
whilst  writing  this  article  I  have  administered  it  in  #ve 
grain  doses  with  the  ipecac,  to  a  patient  presenting  these 
symptoms,  with  the  addition  of  hurried  respiration, 


ACUTE  PLEURITIS. 


259 


every  three  or  four  hours,  with  the  happiest  effects. 
This  remedy  has  been  much  overlooked  in  winter  epi- 
demics. 

If  the  pain  in  the  side  should  be  very  acute  you 
should  give  a  pediluvium  (foot  bath)  either  with  mus- 
tard or  ley,  "and  in  conjunction  with  these  means  it  will 
be  necessary  to  apply  the  following  fomentation  to  the 
side  :"  take  a  couple  of  red  pepper  pods  put  into  a  pint 
of  good  brandy,  simmer  them  together  for  a  few  minutes, 
then  dip  flannels  in  the  same  and  apply,  as  long  as  you 
are  applying  do  not  suffer  them  to  get  cool.  "  Should 
this  fail  to  relieve,  apply  the  following  fomentation : 
tanzy,  worm-wood,  hoarhound,  catnip,  boil  all  down 
together  in  a  suitable  quantity  of  water,  enclose  the 
same  in  flannel  and  apply  to  the  side." 

The  following  recipe  I  have  used  as  a  good  expecto- 
rant : 

fy.    Foxglove  leaves,  grs.  xxx, 

Boiling  water  q.  s.  (sufficient  quantity)  to  obtain 

four  ounces  of  strained  infusion.  Add, 
Syrup  of  gum  arabic,  5  iii? 

Kermes  mineral,        grs.  vi,  (sul.  of  antimony  and 

crys'd  carb.  soda, 
Syrup  of  mallows,      5  ?• 

Mix.    To  be  given  in  tea-spoonful  doses ; 
The  following  cataplasm  is  a  good  rubefacient  applica- 
tion in  pleurisy : 

ty.    Powdered  long  pepper, 
—  ginger,  aa,  5  ss. 


White  of  egg,  sufficent  to  mix  well  into  a  paste. 


260 


ACUTE  PLEURITIS. 


Chronic  Form. — The  treatment  in  the  chronic  form 
depends  upon  the  condition  and  idiosyncracy  of  the 
patient,  but  does  not  differ  materially  from  that  already 
stated. 

The  pleurisy  root  infusion,  half  ounce  to  the  pint  of 
boiling  water,  may  be  drank  freely  in  both  varieties. 
It  is  a  good  expectorant  and  diaphoretic. 

It  is  frequently  necessary  to  administer  a  powerful 
sudorific  to  produce  a  determination  to  the  surface,  indu- 
cing perspiration,  and  the  comp.  tlnct.  of  Virginia  snake 
root  will  answer  this  purpose  most  admirably;  it  will, 
at  the  same  time,  lessen  pain,  allay  nervous  excitability, 
and  procure  sleep.  The  following  is  a  recipe  to  prepare 
the  tincture  viz. : 

^.    Pulv.  Virginia  snake  root, 
"  Ipecacuanha, 
"  Saffron, 
"  Camphor, 
"    Opium,  aa.  Sii. 
Good  gin,  six  pints. 
Macerate  for  two  weeks,  express,  and  filter  through 
paper. 

Dose. — One  tea-spoonful  in  some  warm  herb  tea, 
repeated  every  hour,  aided  by  warm  infusions  and  bath- 
ing the  feet,  will  soon  produce  copious  diaphoresis.  In 
this  disease,  however,  you  may  with  safety  give  a  much 
larger  dose. 

The  drinks  should  be  mucilaginous. 

Regimen. — The  diet  should  be  very  light,  avoiding  all 
stimulating  or  heating  substances. 


ACUTE  BRONCHITIS. 


2G1 


ACUTE  BRONCHITIS. 

This  disease  is  one  of  the  respiratory  organs,  and  when 
inflammation  attacks  the  air  passages  and  affects  them 
severely,  it  is  then  termed  bronchitis,  or  inflammation 
of  the  bronchia. 

General  Symptoms. — The  breathing  is  quick  and  shal- 
low, and  to  make  up  for  the  latter  the  patient  breathes 
quickly;  there  is  frequently  severe  constriction  of  the 
chest,  and  soreness  along  the  course  of  the  bronchia.  In 
a  great  majority  of  cases  there  is  considerable  cough, 
and  the  least  action  so  effects  the  bronchial  membrane 
as  to  produce  it. 

Expectoration. — At  first  there  is  nothing  very  peculiar 
or  marked  in  this  respect,  but  as  the  disease  advances 
to  resolution,  or  is  passing  on  to  the  chronic  form,  we 
have  it  then  almost  transparent,  or  thick  opaque,  and 
of  a  whitish  color;  and  I  have  seen  it  appear  very 
black,  this  was,  however,  only  when  the  disease  was 
very  intense. 

The  Pulse. — The  pulse  is  from  80  to  90  in  a  minute, 
with  thirst,  anorexia  and  headache;  there  is  a  great 
variety,  however,  in  the  pulse,  but  for  the  most  part  it 
is  full  and  rather  soft. 

State  of  the  General  Surface. — The  skin  is  most  fre- 
quently dry,  the  tongue  likewise,  covered  with  a  dirty 
white,  but  frequently  considerable  mucus.  The  face  is 
frequently  congested.  There  is,  in  many  cases,  drowsi- 
ness and  headache;  and  I  have  frequently  seen,  at  the 
moment  of  coughing,  the  veins  of  the  neck  greatly  dis- 
tended, and  the  whole  face  become  turgid. 

Progress  of  the  Disease. — "If  the  disease  go  from  bad 


262 


BRONCHITIS. 


to  worse,  the  patient  cannot  lie  down  at  all.  His  face 
becomes  livid  from  the  congestion.  The  lips  become 
purple,  and  I  have  seen  the  face  become  really  black — of 
such  a  hue  that  I  could  not  have  believed  it  had  been 
the  result  of  bronchitis  if  I  had  had  it  represented  to 
me.  It  was  as  dark  as  when  a  patient  has  taken 
nitrate  of  silver  to  a  great  amount,  or  where  there  has 
been  a  communication  between  the  two  ventricles  of  the 
heart.  The  pulse,  at  last  becomes  weaker  and  softer, 
and  at  the  very  last,  vermicular,  (a  crawling  sensation, 
as  that  of  a  worm.)  The  surface  becomes  blue,  and 
both  the  forehead  and  chin  are  bedewed  with  a  cold, 
clammy  perspiration.  In  this  state  of  things  the  expec- 
toration becomes  very  scanty,  or  ceases  altogether;  not 
because  it  is  not  secreted,  but  because  the  patient  is  too 
weak  to  expectorate  it ;  so  that  he  may  almost  be  said 
to  be  drowned  inwardly  with  mucus.  In  cases  which 
are  left  to  themselves,  or  badly  treated,  it  is  said  that 
dyspnoea,  (shortness  of  breathing,)  comes  on  about  the 
fifth  or  sixth  day,  and  is  followed  by  death." 

If,  on  the  other  hand,  improvement  takes  place,  the 
constriction  is  removed.  The  cough  is  not  much  dimin- 
ished, but  it  does  not  hurt  the  patient  as  it  did.  There 
is  copious  expectoration.  The  pulse  becomes  slower 
and  softer,  without,  however,  becoming  so  soft  as  in 
health.  The  surface  perspires,  and  the  tongue  becomes 
moist.  Still  if  the  case  be  severe,  there  is  a  discharge 
which  appears  to  be  puriform.  In  other  cases,  the 
patient  neither  gets  well  nor  dies  suddenly,  and  there  is 
considerable  expectoration.  Still  the  pulse  is  kept  up, 
and  still  it  is  hard.  In  consequence  of  the  cough,  he 
does  not  gain  strength,  but  perhaps  becomes  more  and 


BRONCHITIS. 


263 


more  emaciated.  He  has  night-sweats,  and  at  the  end 
of  many  months  he  may  die,  or  get  nearly  well;  and 
then  when  he  is  exposed  to  a  common  cold,  he  may 
have  difficulty  of  breathing,  and  more  or  less  bronchitis ; 
so  that  some  persons  who  have  been  ill,  will  never  be 
able  to  get  through  a  winter  without  an  attack  of 
asthma — that  is,  shortness  and  great  difficulty  of  breath- 
ing. There  are  a  great  variety  of  symptoms  afforded 
by  auscultation  as  well  as  by  percussion,  but  as  we  have 
before  remarked,  these  subjects  have  been  investigated 
so  minutely  by  other  writers,  that  I  refer  the  medical 
reader  to  them,  and  for  the  mass  of  readers,  it  is  a 
branch,  which,  without  study,  would  afford  no  interest 
or  instruction. 

Treatment. — The  treatment  of  this  disease  is  perfectly 
easy.  When  the  patient  is  of  full  habit,  and  much 
fever,  we  resort  to  the  aconite ;  if  it  should  fail,  then 
the  lancet  is  decidedly  indicated,  and  antiphlogistics 
generally  and  counter-irritants ;  but  in  mild  cases,  we 
resort  to  nauseating  and  stimulant  diaphoretics  and  ex- 
pectorants. The  vegetable  diaphoretics  are  in  conside- 
rable repute,  but  we  prefer  the  combination  of  tartarized 
antimony  (we  think  it  answers  well  in  this  disease)  and 
ipecac.  We  sometimes  prescribe  a  cough  mixture,  com- 
posed of  a  narcotic,  a  nauseating  ingredient,  and  some 
mucilaginous  matter.  Should  your  patient  be  robust, 
and  you  are  called  early,  you  must  resort  immediately 
to  the  remedies  we  have  suggested.  If,  however,  the 
secretion  has  taken  place,  and  the  patient  is  reduced, 
then  there  is  some  considerable  danger  in  the  lancet,  as 
it  prevents  the  expectoration,  and  causes  greater  dys- 
pnoea, (difficult  breathing;)  in  this  state  of  the  case,  we 


2G4 


BRONCHITIS. 


must  resort  to  vegetable  emetics — serpentaria  (snake 
root)  or  carbonate  of  ammonia ;  when  the  secretion  is 
lymph-like,  we  must  resort  to  an  alterative  course — the 
emetic  and  expectorant  treatment.  But  to  recapitulate, 
we  have  only  to  use  the  aconite  or  bleed  the  patient 
well,  and  to  follow  it  up  by  local  bleeding.  I  generally 
cup  over  the  root  of  the  lungs,  and  behind  on  each  side 
of  the  spine.  I  am  quite  sure  that  mercury  is  of  great 
use  in  this  disease ;  if  you  do  not,  however,  wish  to 
resort  to  mercury,  you  can  exhibit  tartar  emetic  in  large 
doses,  so  as  to  keep  the  patient  nauseated.  In  many 
inflammations  it  would  be  dangerous  to  practice  vomit- 
ing ;  but  in  bronchitis,  many  trust,  next  to  bleeding,  to 
the  exhibition  of  full  doses  of  tartar  emetic — a  grain  or 
more  every  two  hours.  I  need  not  recommend  blisters, 
low  diet  and  moderate  purging,  as  their  application  is  so 
common,  all  know  them  to  be  serviceable.  The  treat- 
ment is  that  of  common  inflammation,  and  if  it  be  well 
practised  in  time,  and  if  the  patient  be  not  the  subject 
of  chronic  bronchitis,  the  treatment  is  easy  enough.  If 
the  patient  have  acute  supervening  on  chronic  disease, 
our  chance  is  slight,  but  even  then  the  case  must  be 
treated  on  the  same  principles. 

Some  rely  entirely  on  lobelia  and  the  tincture  of 
blood-root,  in  equal  parts.  Dose,  a  table-spoonful,  chil- 
dren in  proportion,  to  be  repeated  as  often  as  there  is 
much  accumulation  of  mucous. 

The  feet  should  be  frequently  bathed,  and  counter 
irritation  to  the  extremities. 

In  the  chronic  form,  the  treatment  is  much  the 
same,  two  tea-spoonfuls  of  the  syrup  of  white  poppy 
may  be  given  to  allay  irritation,  when  the  cough  is 


BRONCHITIS. 


265 


troublesome ;  this  is  recommended  also  in  the  acute 


form.    In  the  chronic  form,  the 

Anisated  ammoniated  alcohol,  5i- 

Syrup  of  mallows,  Si- 

Ext.  of  henbane,  9i. 


Mix,  and  given  in  desert-spoonful  three  times  a-day, 
has  some  celebrity. 

You  will  find  the  dried  root  powdered,  of  Indian  tur- 
nip, in  ten  grain  doses,  given  in  an  emulsion  of  gum 
arabic  several  times  a-day,  a  very  valuable  remedy  in 
chronic  catarrh,  chronic  bronchitis,  and  rheumatism. 
My  friend,  Dr.  Kogers  of  Chappel  hill,  says  that  the 
iodide  of  calcium,  ten  grains,  in  combination  with  the 
extract  aconite,  six  grains,  made  into  six  pills,  and  give 
one  every  four  hours,  will  be  found  valuable  in  -  the 
chronic  form.  . 

The  following  prescription  we  have  used  in  bron- 
chitis, especially  when  the  cough  was  bad  : 


^.    Ext.  Opium,  grs.  i. 

"    peruvian  bark,  grs.  iv. 

Camphor,  grs.  vi. 

Sugar,  5i. 

White  linctus,  £iv. 


Mix.  It  can  be  given  with  success  when  the  cough 
is  troublesome. 

Kreosote  and  monesia,  are  both  extolled  in  either 
form  of  bronchitis.  I  cannot  speak  of  their  action,  I 
have  never  used  either  in  this  disease. 

In  the  chronic  mucous  and  muco-purulent  bron- 
chitis, there  is  no  remedy,  I  fully  believe,  (and  I  have 
certainly  tested  a  great  many,)  that  possesses  anything 


2G6 


PNEUMONIA. 


like  the  controlling  power  over  the  super-abundant 
quantity  of  secretion,  as  is  done  by  the  acetate  of  lead. 
I  <ave  it  in  doses  of  one  or  two  grains,  with  the  extract 
hyosciamus,  and  a  grain  of  squills  three  or  four  times 
a-day. 

The  following  is  a  recipe  of  much  value,  in  this  dis- 
ease : 

R.    Pulv.  gum  ammoniacum,        grs.  v. 
Sal.  cupri,  (copperas,)  gr.  i. 

every  three  hours  in  this  disease. 

PNEUMONIA. 

Pneumonia. — We  commence  with  this  disease,  with  a 
degree  of  anxietj^,  that  is  easily  accounted  for.  We 
have  seen  many  consigned  to  the  silent  tomb,  from  its 
ravages,  and  we  only  hope,  and  hope. is  the  staff  of 
all  mankind,  that  our  efforts  to  make  this  disease  per- 
fectly understood,  may  be  successful.  And  we  are  satis- 
fied that  if  strict  care  be  observed  in  carrying  out  our 
directions,  that  the  fatality  of  this  disease  will  be  less- 
ened, while  its  subjects  will  be  no  less  few. 

Pneumonia  is  inflammation  of  the  parenchyma  (which 
is  composed  of  agglomerated  globules,  united  by  areolar 
tissue,  and  tearing  with  more  or  less  facility,)  of  the 
lungs;  it  commences  either  as  bronchitis,  or  it  may 
arise  in  the  substance  of  the  lung ;  the  common,  ordi- 
nary, and  well  known  symptoms  of  this  disease,  are 
very  much  like  those  of  bronchitis — there  is  great 
rapidity  of  respiration,  with  shallowness  of  the  same ; 
general  feverishness,  with  cough  and  expectoration. 
In  bronchitis  there  is  great  constriction  in  the  chest, 
with  soreness  upon  coughing;  in  pneumonia,  if  there 


PNEUMONIA. 


267 


be  any  pain,  it  is  generally  a  deep  seated  dull  pain,  fre- 
quently diffused,  and  so  mild  in  its  character,  that  it 
is  somewhat  difficult  to  arrive  at  a  correct  diagnosis 
from  it. 

Character  of  the  Sputa. — According  to  Laennec,  a 
decided  difference  with  regard  to  expectoration  exists. 
My  observation  as  to  the  character  of  the  fluid,  confirms 
me  in  the  opinion,  that  it  is  most  generally  a  bloody 
serum.  I  have  seen  cases  where  it  was  marked  by  vis- 
cidity and  transparency ;  and  it  generally  passes  through 
the  stages  of  lymph  and  pus.  I  have  seen  it  of  great 
tenacity,  almost  the  consistence  of  jelly ;  so  much  so, 
that  it  would  partially  hang  from  the  vessel's  mouth, 
whilst  the  great  bulk  would  remain  adhered  to  the 
bottom.  My  opinion  is,  that  little  confidence  can  be 
depended  on  the  sputa  as  a  means  of  diagnosis.  Pneu- 
monia has  generally  been  divided  into  four  stages ;  by  some 
authors  into  three.  We  say  there  is  1st,  engorgement ; 
2d,  hepatization,  or  sohdification ;  3d,  yellow  induration, 
and  4th,  softening  and  removal  by  expectoration.  We 
have  also  the  functional  signs,  which  are  general,  local, 
and  secondary ;  we  have,  in  the  majority  of  cases,  a 
bronchitic  cough  at  first ;  it  soon  becomes  suppressed  or 
pneumonic  in  its  character,  and,  in  a  great  variety  of 
cases,  the  cough  is  absent,  the  frequency  of  the  respira- 
tion is  greatly  increased,  and  if  only  one  lobe  is  affected, 
we  have  from  forty  to  fifty  respirations  in  a  minute  5 
but  if  both,  we  have  from  fifty  to  sixty,  and  so  in  pro- 
portion to  the  extent  of  the  mischief.  The  pain,  as  we 
before  observed,  was  very  variable,  depending  entirely 
upon  the  amount  of  inflammation  of  the  pleura.  When 
it  is  deep  seated,  the  pain  is  slight,  and  in  the  old  and 
infirm  the  pain  is  scarcely  felt.    If  an  abscess  should 


2G8 


PNEUMONIA. 


form,  there  is  generally  a  large  quantity  of  purulent 
matter,  sometimes  suddenly  discharged. 

This  disease  generally  affects  secondarily  almost  all 
the  important  organs.  We  have,  as  the  result  or  com- 
bination attendant  upon  it,  pleurisy.  The  heart  is 
sometimes  affected,  the  brain  also,  and  if  the  cerebral 
symptoms  are  severe,  for  the  time  being,  it  will  mask 
the  affection  of  the  lung,  the  stomach,  bowels,  pharynx, 
and  kidneys,  but  most  frequently  the  liver,  and  when 
this  is  the  case,  to  any  great  extent,  the  disease  is  then 
styled  bilious  pneumonia.  We  have  general  symptoms, 
such  as  an  effusion  of  one  or  both  cheeks,  and  the  whole 
countenance  modified  by  the  dyspnoea  (difficulty  of 
breathing).  There  is  considerable  excitement  in  the 
general  circulation ;  after  a  slight  chill,  fever  sets  in, 
increasing  with  the  close  of  the  day,  and  the  pulse  is 
full  and  hard  at  the  commencement  of  the  disease,  and 
in  the  latter  stages  it  is  often  frequently  from  100  to 
120  in  a  minute.  The  excessive  pain  in  the  side  or 
breast,  sometimes  occurring  in  this  disease,  together 
with  the  cough  and  difficulty  of  breathing,  seem  to  call 
for  active  and  speedy  remedies.  The  pulse  is  sometimes 
so  contracted,  and  absolutely  in  many  cases  so  low,  it 
would  seem  to  forbid  the  loss  of  blood,  but  we  have 
seen  it  in  such  cases  often  rise,  upon  the  use  of  the 
cups  freely  applied.  Physicians,  in  such  cases,  resorting 
to  this  remedy,  are  frequently  reprobated  by  many 
people.  The  propriety  of  bleeding,  which  I  view  in  a 
large  majority  of  cases  as  of  doubtful  utility,  is  of  course 
to  be  determined  by  the  pulse ;  and  there  are  cases  in 
which  bleeding  is  justifiable ;  all  other  remedies  will  fail 
to  save  the  fife  of  the  patient  probably  without  this,  but 
these  cases  seldom  present  themselves. 


PNEUMONIA. 


2G9 


First  Stage. — In  the  first  stage  of  inflammation  of  the 
air-cells,  the  lung  merely  suffers  an  accumulation  of 
blood,  so  that  it  becomes  more  solid  and  heavier  than 
usual. 

Second  Stage. — When  the  inflammation  has  become 
more  intense,  so  as  to  constitute  the  second  stage,  the 
lungs  are  heavy,  and  they  become  so  firm  as  to  resemble 
liver ;  and  on  this  account  the  term  hepatization,  or  soli- 
dification, has  been  applied. 

Third  Stage. — Before  death,  however,  a  still  further 
change  will  take  place.  After  the  second  stage,  when 
the  third  begins,  the  lungs  are  as  hard  as  before ;  but  they 
become  yellowish,  or  of  a  straw  color. 

Fourth  Stage. — We  have  cavernous  respiration  with 
gurgling,  and  percussion  flat. 

Its  Progress. — This  disease  is  frequently  fatal,  when 
its  extent  is  not  very  great,  and  when  even  it  has  not 
passed  the  first  of  these  stages ;  all  three  of  the  stages 
have  been  discovered  in  the  same  lung. 

Usual  Seat  of  the  Disease. — It  is  very  remarkable  that, 
in  the  greater  number  of  instances,  the  inflammation 
commences  at  the  lowest  part  of  the  organ,  and  it  may 
not  extend  higher.  The  right  lung  is  more  frequently 
affected  than  the  left. 

Prognosis  is  variable,  if  complicated  with  the  heart, 
brain  or  liver,  it  is  very  unfavorable ;  its  duration  in 
mild  cases,  is  from  ten  to  twenty  days. 

6  The  varieties  of  pneumonia  are  very  great.  Thus, 
while  at  one  time  it  is  marked  by  the  most  highly  in- 
flammatory symptoms,  at  others  it  is  characterized  by 
typhoid  phenomena,  or  by  the  presence  of  bilious  symp- 
toms, such  as  yellowness  of  the  skin,  of  the  sputa  and 
other  excretions.    The  extent  of  the  disease,  whether 


270 


PNEUMOMIA. 


occupying  one  or  both  lungs ;  its  form,  whether  lobar 
or  lobular;  the  age  of  the  patient,  and  other  circum- 
stances, give  rise  to  important  modifications.  It  has 
been  already  observed,  that  lobular  pneumonia  is  espe- 
cially met  with  in  children.  Indeed,  this  is  the  form 
usually  met  with  in  those  who  are  not  over  six  years 
of  age.  The  same  obscurity  often  attends  the  inflam- 
mation of  the  lung,  which  comes  on  in  the  course  of 
other  diseases.  When  supervening  in  the  course  of 
severe  acute  febrile  diseases,  especially  of  a  low  grade, 
the  access  of  pneumonia  may  be  marked  merely  by  a 
sudden  increase  of  fever  and  prostration,  and  its  symp- 
toms are  often  masked  by  those  of  the  principal  affec- 
tion. By  the  careful  employment,  however,  of  auscul- 
tation and  percussion,  we  may  generally  succeed  in 
arriving  at  a  satisfactory  conclusion,  where  an  aggra- 
vation of  the  symptoms  has  already  led  us  to  suspect 
that  some  fresh  disorder  has  supervened  upon  the  pre- 
vious affection.' 

Causes.  —  We  have  already  remarked,  that  pneu- 
monia is  frequently  the  result  of  a  secondary  affection, 
and  there  are  a  variety  of  different  circumstances  that 
may  combine  in  producing  it;  the  principal  cause,  how- 
ever, of  producing  idiopathic  pneumonia,  (primary  affec- 
tions,) is  certainly  cold ;  and  although  it  may  be  met 
with  in  every  variety  of  climate,  yet  it  is  more  preva- 
lent in  cold  regions, — it  is  evident  between  the  tropics 
it  is  less  prevalent,  and  the  simple  cause  why  it  has 
been  so  frequent  and  so  fatal  in  Texas,  is,  that  we  are 
subject  to  such  frequent  and  brisk  variations  in  our 
temperature, — it  is  most  frequent  during  winter  and 
spring,  and  diminishes  rapidly  as  summer  advances. 
The  individuals  most  likely  to  be  attacked,  are  those 


PNEUMONIA. 


271 


most  exposed  to  atmospheric  vicissitudes,  as  well  as  to 
those  circumstances  calculated  to  favor  their  influence, 
such  as  fatigue  and  privations.  The  greater  prevalence 
of  the  disease  amongst  men  which  has  been  proverbial 
in  this  country,  is  in  our  opinion  owing  to  the  circum- 
stance, that  they  are  much  more  exposed  to  these 
causes  than  females.  It  is  almost  certain,  when  a 
patient  can  trace  his  attack  to  any  particular  circum- 
stance, that  it  is  found  in  a  great  majority  of  cases  to 
be  cold,  such  as  exposure  to  a  draft  of  air,  a  check  of 
perspiration,  or  something  of  this  character.  Cold  and 
heat  applied,  in  the  way  which  I  mentioned  in  the 
foregoing  part  of  this  work,  is  frequently  the  cause  of 
this  disease,  as  well  as  of  inflammatory  diseases  in 
general. 

Treatment. — The  treatment  of  this  disease  is  that  of 
any  inflammation;  but  I  would  here  suggest,  as  the 
basis,  that  aconite  and  the  cups,  freely  applied,  is  the 
sheet  anchor  of  our  hope  in  a  large  number  of  cases; 
consequently  the  first  indication  is  to  push  aconite  and 
cup  freely,  especially  in  persons  of  robust  constitutions; 
and  if  the  attack  is  highly  inflammatory,  this  may  be 
repeated  according  to  circumstances,  and  whenever  the 
pulse  justifies  it  we  should  not  shrink  from  the  responsi- 
bility. There  are  cases  where  we  would  use  the  lancet, 
and  in  such  cases  there  is  one  great  consideration  to 
keep  before  you,  that  is,  bleed  for  effect,  not  for  quantity. 
When  you  are  called  late  in  the  disorder,  of  course  you 
will  have  to  modify  your  treatment;  but  even  then  you 
should  try  the  effects  of  local  depletion.  In  the  acute 
stages,  the  cupping  and  aconite  will  be  of  much  more 
benefit  than  general  depletion;  but  nevertheless  it  is 
contended  by  many,  that  the  latter  exerts  the  best  influ- 


272 


PNEUMONIA. 


ence  in  the  advanced  stages  of  the  disorder.  In  this  I 
differ  from  the  mass  of  authority. 

There  is  a  great  error  in  practice,  and  to  the  mortifi- 
cation of  the  intelligent  portion  of  the  profession,  it  is 
too  frequently  indulged  in,  that  is,  blistering  in  the  acute 
stage  of  the  disorder.  Such  practice  is  detrimental  to 
the  patient,  and  calculated  to  do  great  harm;  but  by 
applying  them  in  the  third  stage  great  benefit  may  be 
expected  from  them,  as  they  will  then  check  the  inflam- 
mation and  prevent  collapse;  they  should  be  applied 
under  the  arms,  and  between  the  shoulder  blades  (sca- 
pula) and  spine.  Eubefacients,  should,  in  this  stage, 
also  be  used,  as  they  act  as  stimulants,  and  give,  in 
many  cases,  great  relief  in  the  dyspnoea,  (difficulty  of 
breathing.) 

Ipecacuanha. — This  is  a  great  auxiliary  in  the  treat- 
ment of  this  disease,  and  in  fact  I  place  great  reliance 
upon  it  in  my  own  practice.  I  have  had  the  satisfaction 
of  seeing  this  remedy  relieve  many  cases.  It  can  be 
administered  either  as  a  diaphoretic,  expectorant  or 
sedative;  I  think  it  exerts  these  influences  superior  to 
tartar  emetic,  the  action  varying  according  to  the  quan- 
tity given — the  administration  for  its  best  effects  de- 
pends, of  course,  on  the  judgment  of  the  attendant.  It 
is  frequently  highly  necessary  to  attempt  the  contra- 
stimulant  plan ;  this  is  effected  by  giving  ipecac,  and 
quinine  in  large  doses,  continuing  it  for  twenty-four 
hours,  and  then  diminishing  the  dose  till  the  third  day ; 
frequently  active  emesis  and  catharsis  are  produced 
from  this  plan  of  treatment;  and  to  obviate  and  arrest 
the  emesis  and  catharsis,  you  should  combine  opium 
with  the  ipecac,  and  quinine.  You  should  not  neglect 
here  that  remedy  which  exerts  great  action  over  the 


PNEUMONIA. 


273 


general  system,  I  allude  to  podopliyllin  and  mercury. 
Either  acts  as  an  anti-phlogistic,  (opposed  to  inflamma- 
tion,) in  this  disorder.  It  should  be  administered  so  as 
to  produce  a  general  and  active  impression  upon  the 
general  system,  in  doses  of  either  from  a  quarter  to  half 
a  grain,  in  combination  with  two  or  three  grains  of  ipe- 
cac, every  hour.  If  your  patient  commences  sinking 
rapidly,  you  should  administer  stimulants  and  give 
expectorants,  such  as  eupatorium,  (bone  set,)  serpenta- 
ria,  (Virginia  snake  root.)  [See  pleuritis  for  this  reme- 
dy.] These  general  principles  of  treatment,  if  observed, 
will  have  a  great  tendency  to  moderate  the  worst  of 
cases,  and  relieve  many.  As  this  a  disease  of  so  much 
importance,  we  will  attach  a  synopsis  of  the  treatment 
of  some  distinguished  practitioners,  and  afterwards 
recapitulate  our  own.  Dr.  Elhottson  affirms  that 
patients  have  borne  the  loss  of  blood  to  an  immense 
quantity:  perhaps  more  in  this  disease  than  in  most 
others.  It  is  in  this  affection  that  those  enormous 
bleedings  which  I  mentioned,  but  of  which  I  have  little 
experience,  are  reported  to  have  taken  place — several 
gallons  in  the  course  of  a  few  days.  Mercury  is  of  the 
same  use  in  this  affection  as  in  bronchitis,  and  in  bron- 
chitis as  in  other  inflammatory  diseases.  The  same 
gentleman,  with  Dr..  Stewardson,  says,  "The  loss  of 
blood  has  always  been  the  great  resource  in  the  treat- 
ment of  this  disease.  Not  only  does  it  lesson  the 
inflammatory  ^action,  but  it  diminishes  the  amount  of 
labor  which  the  lung,  already  less  able  to  perform  its 
duty,  owing  to  an  engorgement  of  a  part  of  its  structure, 
is  called  upon  to  perform.  By  lessening  the  quantity 
of  blood  which  passes  through  the  organ,  we  lessen  its 
activity.  These  circumstances,  as  well  as  the  import- 
18 


274 


PNEUMONIA. 


ance  of  the  organ  to  life,  render  free  venesection,  when 
ever  the  general  system  will  admit  of  its  employment, 
especially  important  and  useful,  and  often  absolutely 
imperative.  It  is  scarcely  necessary  to  remark,  that 
topical  depletion  by  cups  or  leeches  may  be  resorted  to 
after  general  depletion  is  no  longer  advisable,  and  is 
sometimes  particularly  useful  in  relieving  the  local  pain 
and  uneasiness. 

Next  to  bleeding,  one  of  the  most  powerful  agents  in 
controlling  inflammation  of  the  lungs,  is  tartar  emetic  in 
large  doses ;  physicians  in  the  United  States  generally 
give  from  two  to  six  grains  in  the  twenty-four  hours, 
but  most  of  them  place  their  chief  reliance  on  calomel. 
This  remedy,  alone  or  combined  with  opium,  is,  perhaps, 
one  of  the  most  efficacious  to  which  we  can  resort.  This 
is  the  treatment  of  eminent  gentlemen,  and  by  following 
this  treatment  I  have  myself  lost  many  patients. 

It  is  unnecessary  to  allude  to  all  the  usual  adjuvants 
of  an  antiphlogistic  course  in  reference  to  diet  and  re- 
gimen. The  patient  should  be  kept  perfectly  quiet,  his 
shoulders  moderately  elevated,  and  the  most  perfect 
repose  enjoined,  at  the  same  time  that  the  position 
should  be  occasionally  changed  in  order  to  prevent  the 
congestion  of  blood  in  the  depending  portions  of  the 
lungs;  the  most  rigorous  diet  should  be  enjoined,  and  mu- 
cilages, with  narcotics  resorted  to,  to  allay  the  cough  and 
pain  and  procure  comfortable  rest.  The  efficacy  of  blis- 
ters is  doubted  by  some  practitioners,  and  applied  at  too 
early  a  period,  before  the  excitement  is  sufficiently  reduc- 
ed, they  may,  as  is  well  known,  aggravate  the  disease. 
It  is  scarcely  necessary  to  observe,  that  in  a  disease 
which  presents  itself  under  such  a  variety  of  forms, 
corresponding  modifications  of  treatment  are  demanded. 


PNEUMONIA.  275 

It  is  now  an  established  fact,  that  in  pneumonia  there 
is  a  total  absence  of  the  chloride  of  sodium  from  the 
urine,  at  or  about  the  period  of  hepatization. 

The  history  of  the  past  teaches  us  that  neither  exces- 
sive bleeding  nor  the  expectant  plan  of  treatment  have 
met  with  such  marked  success  as  to  bring  about  the 
exclusive  adoption  of  either  the  one  or  the  other.  And 
it  would  seem  that  a  knowledge  of  this  should  preserve 
humanity  from  any  new  experiments ;  but  the  human 
mind  in  general  seldom  profits  from  the  experience  of 
the  past;  but  the  science  of  medicine  being  one  of  a 
progressive  character,  we  think  we  have  the  undoubted 
right  to  advance  our  ideas  and  mode  of  treatment,  how- 
ever wide  it  may  differ  from  high  authority,  as  I  am 
satisfied  from  practical  experience  of  its  decided  superi- 
ority in  this  truly  alarming  disease.  I  am  aware  that 
such  a  variety  of  opposite  opinions  upon  the  treatment 
of  a  disease  so  well  understood  as  pneumonia,  are  power- 
ful arguments  employed  by  those  who  are  unwilling  to 
concede  that  the  science  of  medicine  is  possessed  of  any 
degree  of  certainty ;  but  let  every  one  cease  to  reproach 
medicine  with  errors  which  are  exclusively  chargeable, 
in  my  opinion,  upon  those  who  are  controlled  by  hy- 
pothesis. 

I  shall  contribute  my  experience  and  mite  with  the 
hope  that  it  will  preserve  our  successors  from  such  peri- 
odical anarchy ;  and  I  hope  my  suggestions  may  have 
an  impartial  investigation.  "  But,"  as  a  distinguished 
author  says,  "  so  long  as  the  human  mind  remains  the 
same,  so  long  as  there  exists  ardent  enthusiasts  to  be 
thrown  into  ecstacies  by  plausible  dogmas,  or  the 
stupidly  incredulous  who  are  ready  to  doubt  the  most 
ordinary  truths,  it  is  to  be  feared  that  we  shall  still 


276  PNEUMONIA. 

witness  the  same  extremes  of  folly,  not  merely  in  refe- 
rence to  pneumonia/'  but  of  many  other  diseases  of 
which  we  shall  attempt  to  treat.  I  set  forth  my  opin- 
ions upon  this  subject  with  extreme  diffidence,  I  have 
not  grown  grey  in  the  practice  of  my  profession,  but  I 
can  claim  an  indefatigible  diligence  and  observation  for 
many  years,  if  this  is  sufficient  to  entitle  it  to  any  con- 
sideration. 

To  recapitulate  the  plan  of  treatment  I  have  adopted 
for  some  years  in  acute  pneumonia,  is  as  follows :  I 
generally  commence  with  the  Homoeopathic  preparation 
of  aconite,  (and  it  is  but  just  to  say,  I  adopted  this  at 
the  suggestion  of  my  townsman  Dr.  Parker,)  say  twelve 
drops  to  two  ounces  of  water,  and  give  a  tea-spoonful 
every  ten  or  fifteen  minutes,  until  it  produces  a  decided 
action  over  the  circulation  and  a  free  determination  to 
the  surface ;  if  there  is  the  slightest  tendency  to  pain 
on  a  full  inspiration  I  cup  freely  over  the  affected  organ, 
I  pursue  the  remedy  and  cups  until  the  pulse  is  reduced 
in  frequency  and  volume,  I  then  give  podophyllin  or 
mercury  as  suggested  in  a  desert-spoonful  of  castor  oil 
every  two  or  three  hours,  until  free  evacuations  are 
produced.  If  reaction  takes  place,  I  again  resort  to 
aconite  and  the  cups,  if,  however,  it  controls  the  circu- 
lation, I  immediately  commence  giving  quinine  in  com- 
bination with  ipecac,  and  antimony,  in  the  following 
proportions :  quinine  five  grains,  ipecac,  two  grains, 
antimony  one-sixth  of  a  grain,  every  tw^o  and  a  half 
hours. 

In  connection,  we  generally  let  the  patient  use  freely 
of  the  following  sudorific  infusion.    Take  : 
Catnip, 

Asclepias,  aa.  Si.      (Pleurisy  root.) 


PNEUMONIA.  277 

• 

Xantliox  berries,  (Prickly  ash.) 

Menthse  viridis,     aa.  £ss.  (Spearmint.) 

Make  a  strong  infusion  and  drink  freely. 

We  have  the  feet  bathed  in  warm  ley  water  every- 
day for  twenty  minutes  or  more,  and  apply  sinipisms  to 
the  legs  at  night.  We  frequently  use  the  fox  glove 
preparation  as  recommended  in  pleurisy ;  also,  the  ex- 
pectorant recipe,  which  will  be  found  under  the  same 
head.  In  following  this  course,  in  connection  with  our 
general  instructions,  you  are  almost  sure  to  give  relief ; 
and  while  most  authors  advise  the  lancet  as  the  sheet- 
anchor  in  this  disease,  I  with  the  same  confidence  advise 
qui  tine. 

In  connection,  we  frequently  use  the  white  liniment. 
Take  the  yolk  of  an  egg,  slowly  add  rose  water,  two 
ounces  and  a  half,  and  rub  together  in  a  mortar ;  then 
add  oil  of  turpentine,  three  ounces ;  oil  of  lemon,  half 
fluid  drachm.  Pour  into  a  pint  bottle  and  agitate,  to 
mix  thoroughly ;  then  add  pyroligneous  acid  one  ounce ; 
shake  quickly  and  briskly.  Keep  it  well  corked ;  apply 
it  to  the  chest  as  a  counter  irritant  rubbing  it  in  with 
a  sponge,  after  which  apply  a  cataplasm  of  pearl  flow- 
ered life-everlasting,  which  in  many  instances  proves 
more  effectual  than  hops. 

Already,  some  have  condemned  the  quinine  treatment 
without  a  trial ;  there  are  many  things  we  know  to  be 
facts,  that  do  not  accord  with  our  reasoning,  and 
although  we  may  not  be  able  to  explain  satisfactorily 
why  quinine  acts  beneficially  in  this  disease,  yet,  never- 
theless, I  am  satisfied  it  does  so.    Give  it  a  fair  trial. 

Typlioid  Pneumonia. — Here  you  will  be  extremely 
cautious  in  the  administration  of  quinine.  You  must 
use  counter  irritation  early;  emollient  anodyne  enema 


278  ASTHMA. 

may  be  prescribed;  great  caution  should  be  used  in  the 
employment  of  a  cathartic  remedy.  In  the  debility, 
you  will  give  wine  whey,  and  the  cold  infusion  of  bark, 
with  acids  in  small  doses,  or  almost  any  of  the  vegetable 
tonics  may  be  administered. 

A  decoction  of  senega  and  carbonate  of  ammonia  will 
be  found  useful. 

When  there  is  muttering  delirium,  I  have  adminis- 
-  tered  musk,  in  3  gr.  doses,  every  three  hours^  with  great 
success. 

The  wild  indigo  is  a  valuable  remedy  in  the  low 
stages  of  typhoid  pneumonia.  Make  a  decoction,  by 
boiling  one  ounce  of  the  powdered  bark  in  2  h  pints  of 
water  down  t®  li.  Give  a  table  spoonful  every  three 
hours. 

ASTHMA. 

Asthma  seems  to  be  a  disease  more  immediately 
alarming  in  appearance,  than  dangerous  in  reality. 

Symptoms. — There  is  a  violent  sense  of  constriction 
of  the  chest,  generally  accompanied  with  wheezing  respi- 
ration ;  it  seems  rather  to  be  a  spasmodic  affection  of 
the  organs  of  respiration.  The  peculiar  respiration  can 
be  heard  without  putting  your  ear  to  the  chest,  or  em- 
ploying a  stethoscope.  It  is  accompanied  by  a  hacking 
cough,  followed  by  some  expectoration.  The  symptoms 
are  so  well  known,  that  we  need  not  here  particularly 
relate  them,  as  almost  every  practitioner  has  witnessed 
an  attack  of  asthma. 

Spasmodic  asthma,  I  have* no  doubt,  is  complicated 
with  organic  alterations  within  the  chest,  (thorax,)  such 
as  emphyema  (a  collection  of  blood  or  pus  in  some 
cavity  of  the  body,  particularly  that  of  the  pleura)  of 


ASTHMA.  27^ 

the  lungs,  structural  changes  in  the  heart  and  great 
blood  vessels ;  and  it  is  probable  that  the  production  of 
the  spasm  consists  in  some  altered  condition  of  the  cir- 
culation through  the  lumxs. 

Treatment. — During  the  fit,  we  generally  apply  flannel 
cloths  wrung  out  of  hot  water,  and  never  suffer  them 
to  become  even  cold.  We  immediately  give  morphine, 
in  combination  with  ether,  and  generally  add  ammonia, 
assafcetida  and  musk ;  if  there  are  any  complications  of  ( 
•  bronchitis,  you  must  be  cautious  in  the  administration 
of  these  remedies.  Dry  cupping  frequently  gives  some 
patients  instant  relief.  Dr.  G.  Rolison  has  suggested  a 
very  simple  and  ingenious  method  of  dilating  the  chest, 
in  this  and  other  spasmodic  affections.  He  recommends, 
that  at  the  end  of  every  inspiration,  or  during  the  expi- 
ration, the  nostrils  and  mouth  be  kept  forcibly  closed, 
so  as  to  prevent  the  act  of  expiration ;  the  patient  will 
thus  be  compelled  to  inspire  for  several  times  without 
expiring,  and  the  consequence  would  be  a  forcible  expan- 
sion of  the  thorax.  We  cannot  speak  from'*our  expe- 
rience of  the  efficacy  of  this  treatment. 

The  dyspnoea,  or  difficulty  of  breathing,  may  be 
moderated  or  assuaged  by  a  variety  of  narcotics.  We 
generally,  as  we  have  before  stated,  employed  morphia 
for  the  mitigation  of  spasm  in  paroxysms  of  asthma,  but 
the  article  in  which  we  have  the  highest  confidence,  is 
stramonium  (Jamestown  weed.)  Take  the  leaves  and 
stalks,  cut  them  up  and  put  into  a  pipe,  and  smoke  like 
tobacco.  The  smoke  descends,  of  course,  into  the  lungs, 
and  when  the  saliva  is  swallowed,  the  remedy  is  intro- 
duced into  the  system  in  that  way  also.  I  now  simply 
suggest,  in  combination  with  this  smoking  remedy,  to 
combine  with  it  a  small  portion  of  opium.    We  have 


^80  ASTHMA. 

never  known  this  suggested,  but  from  my  experience 
you  will  find  it  a  valuable  acquisition  to  assist  in 
relaxing  the  spasm. 

Lobelia  has  been  much  lauded  for  its  beneficial  opera- 
tion upon  asthma.  To  make  the  recipe  which  is  recom- 
mended, you  take  3  oz.  of  lobelia  inflata,  and  macerate 
it  for  fourteen  days  in  3  pints  of  proof  spirits.  Give 
from  fifteen  drops  to  half  a  drachm  every  two  or  three 
hours.  (It  is  said  that  in  the  latter  stages  of  bronchitis, 
in  combination  with  a  few  grains  of  carbonate  of  am- 
monia, that  it  is  a  valuable  remedy.)  Some  contend 
that  they  have  derived  great  benefit  from  immersing 
porous  paper  in  a  solution  of  saltpetre,  and  drying  it ; 
let  the  patient  inhale  the  vapour,  by  burning  it  in  the 
room,  or  smoking  it  in  a  pipe. 

We  have  derived  much  benefit  in  this  disease,  from  a 
domestic  remedy — simply  goose  grease,  strongly  im- 
pregnated with  garlic ;  tea  spoonful  three  or  four  times 
a  day.  Doctor  Fenner  has  tried  nitric  acid  with  very 
satisfactory  results,  given  in  solution  as  strong  as  lemon 
juice,  (ad  libitum.)  I  have  not  tried  this  remedy,  but 
am  inclined  to  think  well  of  it. 

A  valuable  contrivance  to  moisten  the  air  in  the  bed- 
room of  a  person  afflicted  with  asthma,  we  take  from 
the  London  Lancet.  It  consists  of  a  common  six-quart 
saucepan,  with  a  tube  soldered  in  of  sufficient  length  to 
reach  above  the  mantle,  (an  inch  and  a-half  in  diameter) . 
Four  quarts  of  water  will  evaporate  in  about  five  hours. 
A  few  drops  of  ether  poured  in  at  the  top  of  the  tube, 
will  be  useful  and  refreshing.  There  are  many  asth- 
matic cases,  that  may  derive  great  benefit  from  this 
invention. 

M.  Ducros  asserts,  in  the  Gaz.  Med.  de  Paris,  that 


ASTHMA.  281 

experience  has  shown  that  the  application  of  ammonia^ 
at  25°  over  that  part  of  the  cervical  vertebra,  which 
corresponds  to  the  pharyngeal  plexus,  has  the  power  of 
almost  instantly  arresting  most  attacks  of  asthma. 

Asthma,  like  all  other  nervous  diseases,  is  subject  to 
the  most  unaccountable  variation,  and  is  most  uncer- 
tain as  to  the  effects  which  our  remedies  or  the  in- 
fluence of  physical  agencies  produce.  We  have  derived 
as  much  advantage  from  small,  but  frequently  repeated 
doses  of  the  wine  of  ipecac,  with  an  equal  portion  of 
the  tincture  of  castor,  as  from  any  other  remedy. 

The  use  of  strong  coffee,  without  milk  or  sugar,  is 
highly  spoken  of. 

Some  of  the  following  recipes  we  have  used,  with 
decided  advantage  in  spasmodic  and  humoral  asthma. 

Take  Catalpa  pods,  gss.,  water  sufficient  to  obtain  8 
ounces  of  decoction.  Add, 
Seneka,  3ii. 

Oxymel.  squills,  3i- — Give  in  tea-spoonful  doses. 

A  prescription  we  have  used  with  some  degree  of 
success,  is 

Skunk  cabbage  motz  §i. 
Boiling  water,  pint,  1. 

Infuse  in  a  covered  vessel  for  an  hour;  give  an  ounce 
or  two  at  a  dose. 

In  humid  asthma,  the  following  recipe  is  equal,  if 
not  superior  to  any  remedy  that  we  know  of : 

Galbanum,  5ii. 
Vinegar  of  squills. 

Fennel  water,  aa.  giiss. 


282  ASTHMA. 

Spirit  of  mindereris,  (acetate  of  ammonia,)  fljii. 
Nitric  ether,  5L 
Syrup  of  mallows,  gss. 

Mix.    Three  or  four  tea-spoonfuls  a-day. 

In  spasmodic  asthma,  we  have  used  the  tincture  of 
squills,  ten  drops;  nitric  acid,  five  gtts.;  extract  hen- 
bane, three  grains ;  water,  one  fl.  ounce  and  a-half. 

Mix,  and  repeat  every  three  or  four  hours. 

In  chronic  catarrh  and  humid  asthma,  the  following 
has  a  decidedly  good  reputation  : 

I$*.    Elecampane  root,  gi. 

Orris  root,  gss. 

Water,  givss. 
Boil  down  to  two-thirds,  and  strain,  and  add 

Honey,  Sii. 

Gum  ammoniac,  Bi. 

Vinegar,  Sviii. 

Evaporate  to  the  consistence  of  honey,  and  give  a 
spoonful  occasionally. 

A  recipe  that  Dr.  Thompson  recommends  very 
highly,  is, 

Powdered  ipecac,  grs.  vi. 

"       Nitrate  of  potassse,  9iss. 
"       Myrrh,  grs.  xii. 

Mix.  Divide  into  four  powders;  give  one  every 
three*  hours. 

Lobelia  has  of  late  been  highly  extolled.  Although 
a  valuable  remedy,  we  confess  that,  in  this  disease,  it 
has  not  fulfilled  our  expectations.    Our  mode  of  admi- 


ASTHMA.  283 

nistering  it,  has  been  to  give  it  in  powder  in  small  doses, 
or  the  tincture. 

You  will  find,  in  many  cases,  the  following  valuable, 

^.    Cyanuret  of  potassium,  grs.  iv. 
Distilled  water,  Sii. 
Syrup  of  sugar,  5  hi. 

Mix.    A  tea-spoonful  every  two  or  three  hours. 

A  preparation  of  Dr.  Helford's,  which  we  have  never 
•used,  but  I  am  satisfied  it  will  prove  quite  an  acquisi- 
tion in  the  treatment  of  this  disease. 

R.    Ext.  stramonium.  5ss,  (Jamestown  weed.) 
Soap,  oi. 
Pulv.  gum  arabic.  9i. 
Mucilage  of  tragacanth,  sufficient  to  make  mass. 
Divide  into  thirty  pills. 
Give  one  three  times  a  day. 

A  tincture  of  swamp  dog  wood  is  reported  to  have 
cured  asthma ;  it  is  made  with  good  whiskey. 

The  compound  tincture  of  cramp  bark  is  highly 
spoken  of  by  eclectics.  It  is  a  powerful  antispasmodic ; 
useful  in  all  nervous  and  spasmodic  diseases,  and  par- 
ticularly valuable  in  asthma.  The  following  is  the 
recipe : — 

R.    Pulv.  cramp  bark,  gii. 
Lobelia  seed,  in  powder. 
Skunk  cabbage  seed,  bruised,  aa  gi. 
Stramonium  (J amestown  weed)  seed,  bruised. 
Capsicum. 

Bloodroot,  in  powder,  aa  Bss. 
Alcohol,  four  pints. 


284  CONSUMPTION. 

Macerate  for  two  weeks,  express  and  filter  through 
paper.  , 

Dose  twenty  to  sixty  drops,  three  times  a  day ;  or, 
during  a  paroxysm,  as  often  as  required. 

The  white  liniment  is  also  valuable  in  this  disease. 
See  pneumonia. 

CONSUMPTION.  % 

This  is  a  disease  seldom  originating  in  this  climate, 
but  from  the  fact  that  our  State  has  got  to  be  an  asylum* 
for  patients  of  this  character,  we  have  concluded  to  point 
out  with  great  brevity  the  prominent  and  reliable  symp- 
toms, with  a  condensed  mode  of  treatment. 

Symptoms.  Cough. — This  is  one  of  the  first  symptoms 
noticed,  it  is  a  short  tickling  cough,  sometimes  hacking, 
accompanied  with  a  little  expectoration  of  mucus,  with 
pain  in  the  chest. 

Stitch  in  the  side. — This  is  generally  compfained  of  low 
down,  you  would  be  inclined  to  place  it  in  the  abdomi- 
nal muscles.    Cough  is  always  worse  at  night. 

State  of  the  surface.  The  skin  and  flesh  becomes  very 
soft  and  flabby.  About  this  time  a  little  fever  presents 
itself,  especially  after  exercise,  on  falling  asleep  the 
patient  is  almost  sure  to  perspire  in  some  part  of  the 
body. 

The  progress  of  all  the  symptoms  of  consumption 
varies  exceedingly.  Frequently  a  very  short  time,  and 
in  other  cases  many  years  elapse  before  the  patient  sinks 
under  the  affection. 

Treatment. — We  will  not  pretend  to  lay  down  any 
precise  rules  for  the  treatment  of  consumption,  but  will 
direct  your  attention  to  general  conclusions,  founded  on 
a  review  of  its  pathology. 


CONSUMPTION 


285 


"We  will  endeavor  to  enumerate  some  of  the  curative 
indications,  and  to  give  a  brief  outline  of  the  principal 
remedies  which  have  been  successively  proposed,  and 
those  recipes  which  have  the  greatest  amount  of  autho- 

ritv  for  their  use. 

»/ 

"  "We  have  the  unvarying  testimony  of  authors  in 
favor  of  a  milk  and  a  vegetable  diet,"  if  the  cow's  milk 
disagrees  it  should  be  boiled,  it  can  be  taken  with  bread 
in  moderate  quantities  frequently.  You  can  use  soda 
water  and  flour  to  the  boiled  milk.  Should  it  disagree, 
light  broths,  animal  jellies,  gellatinous  food,  with  the 
various  preparations  of  rice,  flour,  eggs,  buttermilk  and 
oysters,  have  been  highly  recommended  in  varying  the 
diet, 

The  clothing  should  be  warm,  in*  proportion  to  the 
debility  of  the  patient.  Too  much  must  be  equally 
avoided,  particularly  if  there  is  much  tendency  to  per- 
spiration. 

Exercise  in  the  open  air  is  regarded  as  one  of  the 
most  essential  curative  measures. 

Sea  voyages  are  universally  recommended,  and  travel- 
ling to  select  climate,  can  only  be  of  benefit  in  the  early 
stages  of  the  disease. 

Emetics,  or  remedies  given  to  nauseate,  are  particularly 
recommended.  Their  administration  requires  discrimi- 
nation, and  they  should  only  be  persisted  in  when  their 
effects  are  evidently  favorable. 

The  vapor  or  sulphur  bath  is  highly  extolled. 

Counter  irritation  has  the  testimony  of  almost  every 
ancient  and  modern  author  in  its  favor. 

Taraxicum,  (dandelion,)  digitalis,  (fox-glove,)  prussic 
acid,  sulphur  and  bark,  are  all  highly  extolled — sulphur 
in  particular. 


286 


CONSUMPTION". 


Iodine  is  certainly  a  very  valuable  remedy,  and  has 
not  received  the  attention  it  deserves  as  a  remedy  in 
consumption. 

A  variety  of  other  remedies,  such  as  myrrh,  iron  and 
lead,  have  been  favorably  mentioned  in  connexion  with 
consumption. 

Cod  liver  oil  and  gentian  are  highly  extolled  by  the 
English  physicians,  and,  I  think,  deservedly. 

There  are  many  other  remedies  suggested,  which  we 
have  purposely  omitted. 

We  will  detail  some  of  the  recipes  that  have  the  con- 
fidence of  the  profession,  and  such  as  we  have  tested, 
we  will  allude  to. 

Morton's  remedy,  I  used  in  a  case  in  this  city,  in  con- 
nexion with  my  •friends  either  Dr.  McCraven  or  Dr. 
Holland,  and  with  decided  benefit ;  it  is — 

Hydrocyanic  acid,  gtts/xii. 
Syrup  of  Tolu,  fl.  Bss. 

Then  take,  Powdered  gum  Arabic,  Bss. 

Water,  fl.  Bvii.ss. 

Dissolve  the  two  last  and  add  the  former.  Mix.  A 
table-spoonful  every  three  hours. 

A  favorite  prescription  of  Brera,  is — 

1^.    Chloride  of  barium,  grs.  iv. 

Distilled  water,  fl.  Sii. 

Ext.  hemlock,  grs.  iv. 

Common  emulsion,  lb.  i. 

Syrup,  Si. 

Mix.  To  be  taken  during  the  day,  in  scroflula  and 
phthisis. 

Another  of  Brera's  is — 


CONSUMPTION.  287 

3^.    Iceland  moss,  Sn\ 

Hartshorn  shavings,  Si. 

Water,  1  qt. 

Boil  down  to  a  pint  and  strain ;  add,  wine  of  opium 

xv.  gtts.    To  be  taken  during  the  day. 
Another  of  Brera's  is — 

1^.    Iodide  of  calcium,  grs.  x. 

Ext.  aconite,  grs.  vi. 


Mix.    Divide  into  six  pills.    One  every  four  hours. 

There  is  such  a  multiplicity,  that  I  shall  simply 
allude  to  those  articles,  singly  or  in  combination,  which 
are  entitled  to  any  consideration. — An  electuary  of  Pe- 
ruvian bark  and  sulphur ;  pills  of  kreosote ;  sulphate  of 
copper;  vinegar  foxglove;  ipecac,  and  nitrate  of  potass; 
artificial  goat  milk,  which  is  the  following  : — Fresh  suet 
1  oz.,  put  into  a  muslin  bag,  and  boil  in  two  pints  of 
milk,  sugar  candy  two  drachms,  and  used  ad  libitum. 
Myrrh  and  Canada  balsam ;  compound  extract  of  myrrh ; 
Griffith's  myrrh  mixture,  which  is — 


Myrrh,  3i. 

Sulphate  of  iron,  3i. 

Carbonate  of  potassse,  3i. 

Sugar,  5ii. 

Water,  flgvi. 


Make  mixture.  Table-spoonful  doses  as  a  tonic  in 
consumption,  according  to  circumstances. 

Acetate  of  lead,  iodide  potass,  sulphuret  potass,  and 
charcoal ;  chlorate  potass,  have  all  considerable  reputa- 
tion in  consumption. 

The  two  following  recipes  will  be  found  very  valuable 


288 


CONSUMPTION. 


in  pulmonary  complaints.  I  have  used  them  with  ad- 
vantage : 

^.  Elecampane. 

Asclepias,  aa.  1  lb. — (Pleurisy  root.) 
Macro trys. — (Black  cohosh.) 
Comfrey. 

Eupatorium  perfol. — (Boneset.) 
Hoarhound. 
Sycamore  bark. 
Iceland  moss,  aa.  i  lb. 
Sanguinaria,  i  lb. — (Blood  root.) 

Make  three  and  a-half  gallons  of  syrup,  without 
spirits ;  add  the  saturated  tinctures  of  ictodes  foet. 
(skunk  cabbage,)  and  asarum  canad.,  (wild  ginger,) 
of  each  one  pint;  and  the  tinctures  of  lobelia  and 
cypriped.  pubesc,  (lady  slipper,)  half  pint  each. — 
Dose,  one  or  two  table-spoonfuls  every  three  or  four 
hours.  Or 

^5.  Spikenard. 
Hoarhound. 
Elecampane. 
Comfrey,  aa.  Siss. 
Caulophyllum. — (Blue  berry.) 
Macrotrys. — (Black  Cohosh.) 
Ictodes,  aa.  gi. — (Skunk  cabbage.) 
Eupatorium  perfol. — (Boneset.) 
Lycopus. — (L.  virginius.) 
Ampelopsis,  aa.  £ii. — (Bryonia.) 

Make  two  gallons  of  syrup.  Dose,  from  a-half  to  one 
table-spoonful,  every  three  or  four  hours. 

We  would  suggest,  that  Dr.  King's  cough  mixture,  in 


CONSUMPTION. 


289 


the  incipient  stages  of  consumption,  will  prove  valuable. 
This  is  his  formula ;  take 

Lobelia  seeds. 

Ictodes. — (Skunk  cabbage.) 
Sang. — (Blood  root.) 
Asclepias. — (Pleurisy  root.) 
Assarum  can. — (Wild  ginger,)  aa.  Si. 
Water  and  alcohol,  each,  1  quart. 

Make  a  tincture,  and  mix  with  half  the  quantity  of 
simple  syrup.  A  tea-spoonful  every  two  hours,  and  can 
be  alternated  with  the  two  former  recipes. 

Various  preparations  are  highly  recommended  to 
inhale,  such  as  belladonna ;  we  have  tried  this  means,, 
and  with  us  it  has  been  attended  with  no  advantage. 

The  white  agaric  or  spunk,  is  good  in  checking  the 
night  sweats  in  consumption,  in  doses  from  four  to  six 
grains. 

A  good  counter-irritant  in  pulmonary  affections,  is 
the  following : — Take  pulverized  ipecac,  5ii ;  olive  oil, 
5ii;  lard,  Sss. ;  rub  on  the  skin  for  a  few  minutes, 
once  or  twice  a-day.  If  it  is  desired  to  make  it  more 
active,  add  croton  oil,  one  drachm  and  a-half. 

We  have  more  confidence  in  the  inhalation  of  medi- 
cated vapors,  than  any  other  course  of  treatment. 


DISEASES  OF  THE  STOMACH, 

ACUTE  GASTRITIS. 

Gastritis. — This  term  denotes  an  inflammation  of  the 
mucous  membrane  of  the  stomach,  and  is  characterised 
by  an  almost  constant  and  acute  pain  at  the  pit  of  the 
19 


290 


ACUTE  GASTRITIS. 


stomach,  (the  pain  is  increased  by  pressure  on  the  sto- 
mach, by  inspiration,  swallowing  any  dry  substance,  par- 
ticularly if  it  be  hot,  or  vomiting;)  accompanied  by  con- 
siderable fever,  with  nausea,  sometimes  vomiting  and 
great  thirst.  If  the  disease  is  violent,  we  generally  find 
the  patient  complaining  of  a  great  sense  of  tightness 
across  these  parts.  And  there  is  generally  an  increase 
of  heat  felt  in  the  part,  especially  if  the  hands  are  suf- 
fered to  remain  on  the  stomach  a  few  minutes.  It  is 
not  uncommon  to  find  a  great  tendency  to  hiccup ;  and. 
not  unfrequently  the  patient  complains  of  great  debility. 

I  am  of  the  opinion  that  we  have  more  or  less  gastri- 
tis in  connection  with  our  fevers;  and  I  am  satisfied 
from  observation,  that  in  a  large  majority  of  cases,  we 
have  it  combined  with  most  of  our  inflammatory 
diseases. 

Pulse, — We  will  sometimes  find  it  frequent  and  small, 
soon  becoming  weak  and  thready,  sometimes  full  and 
hard ;  but  there  is  a  great  variety  in  this  respect,  as  much 
if  not  more  than  in  inflammations  of  other  parts. 

The  bowels  are  generally  constipated,  the  urine  very 
scanty  and  high  colored;  the  tongue  has  a  peculiar 
appearance,  being  particularly  red  or  scarlet  along  the 
edges,  and  not  unfrequently  at  the  top,  and  in  the  mid- 
dle we  generally  find  it  covered  with  a  peculiar  flaky  fur. 

This  disease  may  terminate  in  a  few  hours,  or  it  may 
last  some  days,  and  frequently  degenerates  into  the 
chronic  form,  when  wre  have  many  of  the  symptoms  of 
the  acute  in  combination  with  many  more,  for  instance, 
the  tongue,  wdiich  in  the  acute  is  red  or  scarlet  along 
the  edges,  with  a  flaky  fur  in  the  middle,  in  the  chronic 
is  particularly  red  at  the  top  and  margin,  and  the  whole 
tongue  is  covered  with  elevations  something  of  the  char- 


ACUTE  GASTRITIS.  291 

acter  of  papillae;  and  in  this  variety  the  bowels  are 
very  torpid,  the  urine  scanty  and  high  colored,  with  a 
very  dry  skin.  We  have  fever,  sometimes  cough,  and 
frequently  great  complaint  is  made  of  excruciating  pains 
in  the  limbs.  In  farther  connection  with  the  chronic 
symptoms,  we  have  frequent  vomiting  of  a  glairy  fluid, 
acidity  and  flatulence.  The  nervous  system  sometimes 
participates  to  a  considerable  extent,  so  much  so  as  to 
be  of  itself  the  cause  of  many  diseases. 

Games. — They  are  more  prolific  in  this  than  perhaps 
most  any  other  disease.  There  are  a  great  variety  of 
causes,  and  it  would  be  almost  impossible  to  enumerate 
the  various  causes  that  will  produce  gastritis ;  suffice  for 
it  that  gastritis  is  produced  by  the  common  causes  of 
all  inflammations;  cold  draughts  of  water  taken  when 
the  body  is  over-heated ;  it  is  frequently  produced  by 
the  sudden  cessation  of  gout;  it  will  sometimes  arise 
from  sympathy  with  a  diseased  womb;  it  is  also  liable 
to  be  produced  from  the  same  cause  with  the  kidneys. 

Regimen. — All  heating  and  irritating  food  or  drink 
must  be  carefully  avoided;  wines,  spirits,  or  cordials, 
under  no  circumstances,  should  be  admitted,  as  they 
will  never  fail  to  increase  the  disease,  and  when  admi- 
nistered frequently,  produce  sudden  death.  There  is 
generally  great  irritability  of  the  stomach,  and  many, 
from  this  fact,  are  disposed  to  give  an  emetic ;  which,  if 
done,  death  is  almost  sure  to  follow,  unless  the  disease  is 
produced  from  taking  some  acrid  poison,  in  which  case, 
a  gentle  emetic  of  ipecac,  accompanied  with  free  dilu- 
tion, would  be  proper. 

Treatment. — The  lancet  is  highly  recommended.  I 
have  never  resorted  to  it ;  but  I  treat  it  as  I  do  other 


292  ACUTE  GASTRITIS. 

inflammatory  diseases.  I  commence  by  giving  aconite ; 
and  I  regard  no  one  remedy  in  the  acute  gastritis  of 
more  importance  than  freely  cupping  the  region  of  the 
epi  gastrium  (stomach) . 

Constipation  is  almost  a  uniform  attendant  upon  gas- 
tritis ;  but  medicine,  of  almost  any  character,  if  given 
by  the  mouth,  is  either  sure  to  aggravate  the  inflamma- 
tion, or  be  rejected ;  and,  consequently,  I  seldom  advise 
any  medicine  to  be  given.  What  I  use  I  do  endermi- 
cally,  by  applying  a  blister  the  size  of  a  dollar,  and 
sprinkle  upon  the  denuded  surface  fifteen  or  twenty 
grains  of  calomel.  The  bowels  should  be  kept  in  a 
soluble  condition  by  the  free  use  of  enemata  (injec- 
tions) . 

If  the  stomach  will  tolerate  medicine  at  all,  I  fre- 
quently use  sweet  oil,  given  in  doses  sufficiently  large 
to  produce  purgation,  and  it  should  be  repeated  every 
two  hours;  but,  if  found  to  disturb  the  stomach,  it 
should  not  be  persevered  in. 

I  use  flannel  cloths  dipped  in  warm  water,  or  the 
decoction,  as  recommended  in  pleurisy;  these  to  be 
applied  to  the  region  of  the  stomach,  and  never  suffered 
to  grow  cool. 

When  the  pain  is  very  great,  accompanied  with  an 
inclination  to  vomit,  by  removing  a  portion  of  the  cuti- 
cle from  the  blister,  and  sprinkling  on  a  grain  of  mor- 
phine, it  will  frequently  allay  the  iritability,  and  pro- 
cure rest.  When  the  vomiting,  however,  is  obstinate 
and  easily  excited,  advantage  will  frequently  accrue 
from  enemata  (injections)  of  laudanum,  with  a  solution 
of  starch  or  flaxseed  tea. 

The  feet  and  legs  ought  to  be  bathed  in  stimulating 


CHRONIC  GASTRITIS. 


293 


pecleluvia  (bath) ;  and,  for  the  purpose  of  exciting  action 
in  the  lower  extremities,  warm  bricks  or  poultices 
should  be  applied  to  the  soles  of  the  feet. 

"  In  the  last  and  most  prostrate  stage,  when  all  the 
symptoms  indicate  threatened  or  existing  gangrene,  the 
most  efficient  remedy  is  the  oil  of  turpentine,  combined 
with  laudanum  or  a  salt  of  morphia,  and  given  fre- 
quently in  small  doses." 

In  the  early  stages  of  the  disease,  I  allow  nothing  to 
be  given,  unless  it  is  a  little  cold  water,  or  iced  lemo- 
nade ;  in  the  more  advanced  stage,  a  little  nutriment  in 
the  shape  of  a  solution  of  gum  arabic,  or  some  other 
mucilaginous  or  farinaceous  drink ;  but,  where  the  debi- 
lity is  great,  I  have  suffered  the  patient  to  use  fresh 
milk,  with  a  little  lime  water,  in  very  small  quantities, 
every  hour  or  two. 

Every  care  must  be  taken  during  convalescence,  for 
the  least  imprudence  in  eating  would,  without  doubt, 
occasion  a  relapse,  which  would  almost  be  certain  to 
prove  fatal. 

CHRONIC  GASTRITIS. 

Is  so  closely  allied  to  that  of  dyspepsia,  that  most 
authors  make  no  distinction.  It  is  a  frequent  attendant 
upon  phthisis.  We  view  the  two  diseases  as  identical, 
and  I  will,  therefore,  give  my  views  and  treatment 
under  the  head  of  dyspepsia. 

It  is  reputed  that  peach  leaves  exert  a  decidedly 
beneficial  influence  in  all  inflammations  of  the  stomach. 
They  should  be  used  in  cold  infusion,  a  table-spoonful 
every  hour  or  two. 

The   datura   stramonium,  or  Jamestown  weed,  is 


294  DYSPEPSIA. 

highly  extolled  in  gastritis.  The  extract  should  be 
used,  commencing  with  an  eighth  of  a  grain. 

DYSPEPSIA. 

Symptoms.  —  Irregularity  of  the  appetite,  occasional 
nausea,  heartburn,  and  frequently  pain  in  the  stomach ; 
flatulency  of  the  stomach  and  bowels ;  the  food  becomes 
sour,  with  unpleasant  eructations ;  heaviness  or  oppres- 
sion at  the  stomach  after  eating ;  the  food  is  frequently 
ejected  by  mouthfuls,  in  a  half-digested  state ;  occasion- 
ally colic  pains,  and  general  languor  and  debility.  The 
discharges  are  generally  of  an  ash  color.  After  the  dis- 
ease has  lasted  some  time,  the  pulse  becomes  tense  and 
quick,  the  upper  part  of  the  abdomen  tender  to  the 
touch ;  the  patient  becomes  irritable  and  frequently 
desponding. 

Causes. — All  stimulating  substances,  such  as  alcoholic 
drinks,  food  highly  seasoned,  or  that  which  is  of  diffi- 
cult digestion,  irritants,  medicines,  poisons,  hunger, 
thirst,  sudden  changes  of  temperature,  external  irrita- 
tion repeated  by  sympathy  in  the  mucous  membrane  of 
the  stomach;  a  slow  irritation,  which  has  existed  for 
some  time,  and  perhaps  unsuspected  by  the  patient; 
moral  affections  of  a  violent  character,  such  as  anger, 
excess  of  joy  or  grief.  All  these  causes  act  with  an 
energy,  modified  by  the  temperament,  the  predisposi- 
tion, and  the  degree  of  sensibility  of  the  individual. 

That  the  mucous  membrane  of  the  stomach  is  the 
most  frequent  seat  of  irritation,  is  an  incontestible  fact, 
which  may  be  readily  accounted  for,  from  the  numerous 
causes  which  act  upon  this  membrane.  A  distinguished 
physician  has  classified  the  exciting  causes  as  follows : 


DYSPEPSIA. 


295 


First. — By  hunger  and  thirst. 
Second. — By  ingesta  #f  every  kind. 
Third. — By  mechanical  agents,  blows,  contusions,  &c. 
Fourth. — By  emanations  transmitted  by  the  air. 
Fifth. — By  the  circumfusa,  (every  thing  that  acts  on 
man,)  cold,  heat,  humidity,  light,  electricity. 
Sixth. — By  the  moral  affections. 

6  The  great  number  of  cases  unrelieved,  has  served  to 
cast  unmerited  opprobrium  on  the  science  of  medicine, 
and  is,  indirectly,  a  most  fertile  cause  of  the  growth  and 
spread  of  empiricism.  The  weight  of  this  opprobrium 
should  fall  (and  it  would  be  justly,  too,)  on  the  patients 
themselves;  for  it  is  perfectly  useless  to  attempt  to  cure 
this  disease,  unless  the  invalid  is  thoroughly  convinced 
of  the  necessity  of  changing  his  customary  habits,  and 
adopting  a  new  rule  of  conduct,  and  determined  to  per- 
severe in  it  to  the  end/ 

We  shall  allude  to  one  other  cause,  which  our  ex- 
perience teaches  us  is  of  the  most  fruitful  origin,  in  pro- 
ducing •  dyspepsia,  which  is  the  use  of  tobacco.  6  Every 
medical  man  knows  that  the  saliva,  which  is  so  copiously 
drained  off  by  the  pipe  or  cigar,  is  the  first  and  greatest 
agent  which  nature  emplo}7s  in  digesting  food.  Chew- 
ing equally  drains  off  this  liquid,  so  necessary  to  diges- 
tion.' Darwin,  in  his  Zoonomia,  says  : — "  The  unwise 
custom  of  chewing  and  smoking  tobacco,  for  many  hours 
in  the  day,  not  only  injures  the  salivary  glands,  produc- 
ing dryness  in  the  mouth  when  this  drug  is  not  used 
but  I  suspect  its  constant  use  in  many  persons  will  pro- 
duce scirrhus  of  the  liver  and  pancreas.  6  It  injures  the 
power  of  digestion,  by  occasioning  the  patient  to  spit 
out  that  saliva  which  he  ought  to  sw^allow,  and  hence 
produce  flatulency.    It  makes  the  patient  very  nervous, 


29G 


DYSPEPSIA. 


he  has  disturbed  sleep ;  he  is  irascible,  and  it  even  pro- 
duces mental  depression.  Dr.  Brown  says  : — £  That  it 
acts  directly  upon  the  nervous  system,  enfeebling,  ex- 
hausting, or  destroying  the  powers  of  life/ 

Treatment. — You  must  seek  to  ascertain  the  causes  in 
each  particular  case,  which  has  given  rise  to  the  dis- 
ease, and  when  it  can  be  traced  to  any  cause,  either 
eating  indigestible  food,  using  ardent  spirits,  or  want  of 
exercise,  ever  after  tliey  should  he  carefully  avoided. 

I  have  had  considerable  success  in  the  cure  of  this 
disease,  I  restrict  my  patients  to  a  regular  diet,  and 
generally  use  one  article  of  food  at  a  time,  as  the 
stomach  is  more  capable  of  managing  a  simple  than  a 
compound  diet ;  use  as  little  drink  when  eating  as  pos- 
sible; avoid  taking  exercise  immediately  after  eating, 
but  in  an  hour  or  two  afterwards,  exercise  freely.  The 
diet  which  I  esteem  most  highly  in  this  disease,  is  corn 
meal,  baked  in  the  ashes ;  this  can  be  alternated  with 
fresh  lean  beef  cut  thin,  one  pound  put  it  into  a  jar, 
add  a  little  salt,  and  place  the  jar  in  a  kettle  of*  boiling 
water,  let  it  remain  for  an  hour,  and  strain  through  a 
woolen  cloth.  You  can  give  a  tea-spoonful  of  this,  and 
increase  the  quantity  as  the  stomach  will  bear  it.  Occa- 
sionally a  piece  of  stale  wheat  bread,  with  a  little  loaf 
sugar,  covered  with  boiling  water,  and  then  covered  with 
a  plate ;  you  can  add  a  small  quantity  of  milk,  this  is 
apt  to  agree  with  the  stomach. 

The  medicinal  treatment  of  this  disease  is  not  so 
simple  or  plain  as  many  authors  conceive  it  to  be ;  it  is 
true  that  the  stomach  should  not  be  made  a  perfect 
laboratory,  but  a  regular  and  constant  use  of  medicine  is 
indispensable ;  it  must  be  persevered  in,~and  unless  it  is, 
no  good  will  be  attained.    I  have  treated  some  five  or 


DYSPEPSIA. 


297 


six  cases  successfully  in  this  city,  I  used  strychnine  in 
every  instance  with  success,  and  however  desperate  the 
case  may  be,  I  would  advise  giving  it  a  trial.  I  gave  it 
to  Rev.  M.  Cameron  and  Mrs.  John  Brown,  (cases  of  long 
standing,)  who  persevered  in  the  remedy  until  they  were 
perfectly  restored.  *  In  connection  with  this  I  generally 
used  equal  parts  of  rhubarb,  aloes  and  copperas  made 
into  pills,  and  give  sufficient  at  bed  time  to  keep  the 
bowels  in  a  soluble  condition.  My  general  formula  for 
administering  the  strychnine  is  as  follows : 

ty.    Alcohol,        S  iiss. 
Strychnine,    grs.  iii. 

Fiat  tinctura. — To  be  given  in  ten  drop  doses  before 
each  meal,  increasing  a  drop  daily  until  the  patient  gets 
to  twenty,  at  which  point  he  will  stop  increasing  and 
continue  to  take  that  amount.  It  should  be  borne  in 
mind  that  the  activity  of  this  substance  is  increased  by 
all  acid  drinks. 

Dr.  J.  Spurgin,  an  English  physician  of  celebrity,  re- 
commends hi  the  strongest  manner  possible,  what  he 
terms  the  "  liquid  condiment"  for  the  cure  of  dyspepsia, 
which  is  as  follows  :  Liquor  potassas,  chloride  of  sodium, 
(common  salt)  aa.  §  i,  phosphate  of  sodse,  (it  is  some- 
times called  tasteless  purging  salts,  and  not  unfrequently 
neutral  phosphate  of  soda?)  5  iss,  water  3  iii.  As  much 
of  this  solution  may  be  taken  at  a  time  as  will  not  affect 
the  taste  of  the  beverage  disagreeably.  He  says,  in  a 
great  number  of  instances  this  article  has  proved  most 
useful.  Many  families  have  it  on  their  tables  for  daily 
consumption,  and  even  make  their  tea  by  first  putting 
two  or  three  spoonsful  into  the  tea-pot  with  the  tea.  It 
is  not  intended  to  be  resorted  to  as  an  occasional  remedy 


2D8 


DYSPEPSIA. 


for  various  forms  of  indigestion,  but  as  a  constant  prac- 
tice, in  like  manner  as  with  common  salt. 

He  says,  lie  "could  write  a  treatise  to  record  the 
successful  results  of  its  employment,  but  its  utility  needs 
no  corroboration."    I  leave  it  to  its  own  merits. 

There  is  a  variety  of  remedies  laid  down  for  the  cure 
of  this  disease,  none  of  which,  in  our  humble  opinion, 
are  reliable ;  those  that  are  entitled  to  the  most  con- 
sideration I  append  to  this  article,  but  would,  in  a  very 
large  majority  of  cases,  advise  you  to  follow  my  treat- 
ment to  the  letter. 

The  following  recipe  is  frequently  recommended,  viz : 

Bruised  gentian,  5  i,  bruised  rhubarb,  3  ii?  boiling 
water,  twelve  fl.  ounces.  Macerate  for  an  hour,  strain, 
and  add  carbonate  of  ammonia,  (hartshorn)  9  ii.  Dose, 
one  to  two  fl.  ounces. 

I  have  more  confidence  in  the  gentian  and  sulphuric 
acid  mixture  than  any  of  the  compounds  that  are  re- 
commended, which  is, 

Compound  infusion  of  gentian,  fl.  oz.  v. 

  tincture  of  gentian,  5  i. 

Diluted  sulphuric  acid,        fl.,  3  i. 

Mix.  A  table-spoonful  three  times  a  day,  in  dyspepsia. 

There  are  many  formulas  highly  extolled  by  different 
authors  that  I  do  not  think,  from  my  experience  with 
them,  are  worthy  the  attention  of  the  profession. 

A  preparation  I  use,  and  which  will  be  found  useful, 
is  the  following : 

Sulphate  ferri,,      3  i- 
Ext.  gentian,        q.  s. 

Divide  into  thirty  pills,  one  to  be  taken  morning, 
noon  and  night. 


VOMITING. 


The  preparation  of  podophyllin  and  leptandrin,  that 
we  have  had  occasion  already  to  recommend  in  hepatitis, 
will  be  found  an  excellent  alterative  in  dyspepsia. 

VOMITING.  ,* 

Vomiting  proceeds  from  various  causes ;  excesses  in 
eating  or  drinking.  It  is  frequently  the  result  of  metas- 
tasis, (a  translation  of  the  disease  from  some  other  part ;) 
it  may  likewise  proceed  from  the  suppression  of  any  of 
the  customary  discharges,  for  instance  the  piles,  menses, 
&c.  There  are  a  great  variety  of  causes  that  will  pro- 
duce vomiting,  and  there  can  be  no  question  that  at 
times  it  is  purely  of  nervous  origin. 

If  it  proceeds  from  a  foul  stomach  or  indigestion,  it 
will  generally  relieve  itself,  but  may  be  promoted  by 
ipecac,  and  chamomile  tea. 

If  from  retrocession  of  the  gout,  every  means  must 
be  used  to  invite  it  back  to  its  first  locality. 

If  from  weakness  of  the  stomach,  Peruvian  bark, 
sulphuric  acid  or  brandy  will  be  found  beneficial. 

If  from  acidities  in  the  stomach,  your  remedies  will 
be  the  alkalies,  to  neutralize  the  acid. 

If  from  spasmodic  affections  of  the  stomach,  the  aro- 
matics,  such  as  cinnamon  and  spices  boiled  in  wine. 

I  have  used  kreosote  in  drop  doses,  given  in  a  little 
milk,  with  great  success,  in  violent  vomiting.  Any  of 
the  following  recipes  will  be  found  valuable,  under  many 
circumstances.  I  have  frequently  relieved  violent  vomit- 
ing, by  free  cupping  over  the  region  of  the  stomach, 
following  the  cupping  by  rubbing  on  ether.  Mustard 
plasters  over  the  region  of  the  stomach,  frequently  allay 
irritability  of  that  organ. 


300 


VOMITING. 


I  have  used  catechu  in  the  recipe  following,  very  suc- 
cessfully. 

^.    Catechu,  5L 
Columbo,  3ss. 
•Winter  bark,  9i. 
Boiling  water,  £iv. 

MJx,  and  digest  for  eight  hours ;  strain,  and  add  syrup 
of  red  roses,  Si.    Give  in  spoonful  doses. 

In  spasmodic  vomiting,  the  annexed  recipe  will  afford 
relief. 

1^.    Powdered  columbo,  9iv. 
Opium,  grs.  iv. 

Oil  of  peppermint,  gtts.  x. 

Syrup  of  pinks,  q.  s. 

Mix,  and  make  thirty  pills.  Take  2,  three  times  a 
day.  If  the  patient  prefers  the  fluid  form,  give  the  fol- 
lowing : — Columbo,  5ss.  Boil  in  water,  3  to  5  fl.  oz., 
strain  and  add, 

Carbonate  of  potassa,  grs.  x. 

Lemon  juice,  fl.  5iii. 

Tinct.  opii.  gtts.  xii. 

Mix.    Give  from  a  tea  to  a  table-spoonful  every  hour. 

I  prefer  giving  the  kreosote  in  milk,  but  my  friend 
Dr.  Hopkins  assures  me  he  has  used  the  following  with 
the  happiest  results. 

I£.    Kreosote,  1  drop. 

Camphor  water, 

Compound  infusion  of  gentian,  aa.  fl.  5vi. 
Mix,  and  give  half  of  this  mixture. 


VOMITING. 


301 


A  clyster  of  laudanum,  will  frequently  allay  irrita- 
bility. I  generally  use  tincture  opii.  9ii ;  infusion  of 
flax-seed,  two  to  four  ounces,  and  inject. 

The  following  aromatic  plaster,  will  generally  allay 
nausea,  and  relieve  gastric  uneasiness ;  and  it  is  also  a 
good  local  stimulant,  when  applied  to  the  region  of  the 
stomach. 

I^.  Burgundy  pitch,  Siii. 
Yellow  wax,  Sss. 
Powdered  cinnamon,  '  3vi. 

Oil  of  pimento,  (black  pepper,) 
"    lemons,  aa.  3ii. 

Melt  the  rosin  and  wax  together,  and  strain ;  when 
they  begin  to  thicken,  on  cooling,  mix  in  the  cinnamon, 
previously  rubbed  with  the  oils,  and  make  a  plaster. 

I  have  relieved  many  cases,  by  the  administration  of 
ipecac,  in  quarter  to  half  gr.  doses.  Soda  powders,  sul- 
phuric ether  and  strychnine ;  also,  stimulating  clysters 
of  common  salts,  or  salts  with  the  addition  of  the  oil  of 
turpentine,  will  often  afford  relief.  Counter  irritants, 
such  as  stimulating  liniments  and  blisters,  we  have  sug- 
gested. 

Vomiting,  the  result  of  pregnancy,  will  be  frequently 
relieved  by  either  of  the  following,  the  latter  of  which 


is  well  adapted  to  children  : 

fy.    Magnesia  ustae,  3i. 

Aqua  ammonia,  £i. 

Spiritus  cinnamomi,  3iii. 

Distilled  water,  5vss. 


Mix.    A  table-spoonful  four  or  five  times  a  day. 


302  INFLAMMATION  OF  THE  INTESTINES. 

1^.    Aquae  calcis,  (lime  water,) 

Lactis  recentis,  (milk,)         aa.  Siii. 

For  an  adult,  two  table-spoonsful. 

The  two  last  remedies  are  well  adapted  to  the  cure  of 
what  is  commonly  called  the  heart-burn,  and  when  this 
complaint  is  very  troublesome,  it  can  be  relieved  imme- 
diately, by  taking  fifteen  or  twenty  drops  of  the  purified 
soap  lees,  in  a  cup  of  linseed  tea  or  milk. 

A  very  efficient,  yet  a  very  simple  remedy,  will  fre- 
quently allay  vomiting,  when  all  other  means  have 
failed.  I  allude  to  the  leaves  of  the  raspberry,  in  decoc- 
tion with  cream ;  it  will  speedily  allay  nausea,  if  taken 
in  doses  from  one  to  four  ounces. 


DISEASES  OF  THE  INTESTINES, 

ENTERITIS. 

It  frequently  occurs  that  the  irritation,  after  having 
existed  for  some  days  in  the  superior  portion  of  the 
intestinal  canal,  invades  the  inferior  and  lower  portion. 
We  have  acute  deep  seated  pain,  and  this  may  occur  in 
many  parts  of  the  intestinal  region;  the  pain  is  more 
aggravated  at  this  time  than  at  others,  and  increased 
very  much  if  pressure  or  percussion  is  applied  to  the 
abdomen.  The  pains  are  constant  and  violent;  there  is 
no  cessation,  such  as  you  see  in  severe  attacks  of  the 
"gripes"  The  heat  is  intense,  the  thirst  unquenchable, 
and  the  pulse  is  exceedingly  quick.  It  is  generally 
accompanied  with  violent  headache,  and  the  patient,  in 
the  latter  stages,  becomes  delirious,  and  trys  to  get  out 
of  bed,  though  generally  he  will  lay  very  quiet. 


INFLAMMATION  OF  THE  INTESTINES. 


303 


The  tongue,  in  the  first  instance,  grows  white,  and 
the  breathing  is  very  much  accelerated.  Nausea  and 
vomiting  soon  occur.  There  is  obstinate  costiveness, 
and  the  urine  is  very  high  colored. 

If  the  alimentary  canal  be  stimulated  to  action,  the 
tongue  soon  becomes  brown  and  dry. 

Diagnosis. — Enteritis  is  distinguished  from  peritonitis 
by  the  obstruction  that  is  produced,  the  constipation, 
and  the  consequent  effects  of  it — nausea  and  vomiting ; 
and  also  by  the  circumstances  of  the  pain,  it  being  more 
fixed  about  the  region  of  the  umbilicus,  (navel,)  whereas 
in  peritonitis  it  is  generally  much  more  diffused. 

Treatment. — I  have  seen,  in  this  disease,  violence  of 
symptoms  that  would  indicate,  even  in  this  climate,  the 
use  of  the  lancet ;  but  if  employed  it  should  be  exercised 
with  great  caution,  and  in  delicate  constitutions  it  should 
not  be  used. 

To  remove  the  constipation,  and  to  arouse  the  liver  to 
active  secretion,  we  give  either  podophyllin  or  calomel 
in  combination  with  castor  oil,  half  grain  of  the  former 
or  five  grains  of  the  latter,  in  a  tea-spoonful  of  oleum 
ricini,  (castor  oil.)  If  the  disease  should  be  accompa- 
nied with  diarrhoea,  I  use  the  same  remedy,  only  a 
small  portion  of  the  calomel. 

If  there  is  acid  in  the  bowels,  which  is  easily  ascer- 
tained from  the  odor  and  color  of  the  stools,  prepara- 
tions of  magnesia,  or  either  of  the  following  recipes  can 
be  given.  Take 

II.  Rhubarb, 
Saleratus, 

Peppermint  or  spearmint  leaves,  equal  parts. 
Dose.    In  powders,  from  h  to  I5.    It  can  be  used  by 
infusion,  by  taking  si.  of  the  mixture  to  1  pint  of  boil- 


304 


INFLAMMATION  OF  THE  INTESTINES. 


ing  water.  Steep,  strain  and  sweeten.  Dose. — One 
table-spoonful  every  half  hour.    Or  take 

I£.  Podophyllin,  x.  grs.,  and  one  drachm  of  the  rhu- 
barb and  saleratus  mixture.  Mix,  and  give  two  or 
three  grains  every  two  hours  until  the  desired  effect  is 
produced. 

Throughout  the  whole  course  of  the  disease,  the 
bowels  should  be  kept  in  a  soluble  condition  by  the 
administration  of  the  above  remedies,  or  by  neutral  salts 
or  magnesia  and  manna.  If,  however,  the  cathartics 
are  found  to  irritate  the  alimentary  canal,  you.  can  sub-t 
stitute  emolient  enemata,  (injections.) 

You  should  endeavor  to  produce  a  determination  to 
the  surface,  by  inducing  free  perspiration ;  to  do  which 
you  can  give  Dover's  powders,  aqua  ammoniae,  or  the  fol- 
lowing sudorific  infusion.  Take 

1^.  Catnip, 

Asclepias,  (pleurisy  root,)  aa.  Si. 

Xanthox.  berries,  (prickly  ash,) 
MenthsB  viridis,  (spearmint,)      aa.  Bss. 

Make  a  strong  infusion,  and  drink  freely  as  warm  as 
possible;  or  Beach's  Sudorific  Tincture  is  a  valuable 
remedy. 

The  warm  bath  is  a  valuable  adjuvant.  In  the  ad- 
vanced stages,  if  there  should  be  diarrhoea,  I  would 
advise  the  hydrg.  cum.  cretae.  (mercury  and  chalk,)  in 
combination  with  opium,  in  small  but  repeated  doses,  or 
a  mixture  of  nitro-muriatic  acid  and  laudanum. 

The  most  efficient  measure  is  your  active  local  treat- 
ment ;  ascertain  the  seat  of  tenderness  and  cup  it  tho- 
roughly and  effectually.    Warm  fomentations  are  often 


INFLAMMATION  OF  THE  INTESTINES. 


305 


of  great  efficacy,  such  for  example  as  hops,  though  a 
better  can  be  found  in  a  combination  of  lobelia  and 
eupatorium;  it  should  be  applied  for  days.  The  arnica, 
a  favorite  amongst  our  homoeopathic  friends,  is  a  good 
application,  three  parts  water  to  one  of  arnica,  and 
apply  over  the  abdomen.  Frequently  you  will  derive 
advantage  from  combining  garlic  in  mustard  with  your 
cataplasms. 

If  the  disease  should  prove  very  obstinate  after  effec- 
tual cupping,  you  can  apply  a  large  blister  over  the 
abdomen. 

If  the  liver,  brain  or  stomach  should  become  involved, 
you  will  have  to  adapt  jour  treatment  to  the  affected 
organ,  generally  an  antiphlogistic  course  will  be  de- 
manded. 

We  have  already  called  attention  to  the  benefit  to  be 
derived  in  inflammations,  from  the  use  of  a  cold  infusion 
of  peach  leaves,  it  is  highly  serviceable  in  this  affection. 
[See  Gastritis.] 

6  Great  care  is  recpiisite  in  relation  to  the  diet.  In 
severe  cases  accompanied  with  fever,  slippery  elm  or  a 
solution  of  gum  arabic  is  all  that  should  be  allowed  ;  if 
a  more  nutritious  diet  is  necessary,  it  may  consist  in 
farinaceous  drinks,  such  as  rice,  barley,  or  bread  water, 
sago  and  tapioca  may  be  given. 

In  the  declining  stages,  mutton  broth  and  oysters 
may  be  allowed.  In  convalescence,  it  is  equally  as 
important  to  regulate  the  diet  to  avoid  relapse,  the 
lightest  and  most  digestible  articles  of  food  should  be 
employed. 

20 


306 


CONSTIPATION. 


CONSTIPATION. 

Constipation. — Obstruction  or  costiveness,  without  any 
fault  in  the  bowels,  or  any  accidental  obstruction  what- 
ever, frequently  arise  from  persons  neglecting  to  en- 
deavor to  relieve  their  bowels ;  it  frequently  occurs  as 
a  symptom  of  enteritis,  and  it  is  also  accompanied  with 
lesions  of  the  spinal  marrow  and  colic.  We  frequently 
have  irritation  of  the  mucous  coat  of  the  intestines,  and 
constipation  is  most  frequently  to  be  attributed  to  the 
secretions  not  being  formed  in  sufficient  quantity,  which 
is  essentially  necessary  for  the  healthy  action  of  the 
intestines;  the  consequence  is,  the  faeces  are  retained 
longer  than  is  customary  with  the  individual.  I  know 
persons  who  seem  to  be  in  the  exercise  of  their  func- 
tions, and  comparatively  in  good  health,  who  do  not 
have  an  evacuation  over  once  a-week,  and  I  know  of 
some  others  who  go  from  nine  to  thirteen  days.  Now 
this  is  certain  in  the  end  to  give  rise  to  gastric  and  in- 
testinal disorder.  They  will  sometimes,  (the  faeces,)  col- 
lect in  such  quantity  as  to  create  a  mechanical  obstruc- 
tion. One  of  the  principal  causes  in  my  opinion,  is  that 
the  biliary  secretions  are  suspended,  and  from  the  want 
of  the  secretion  of  bile,  torpor  of  the  bowels  is  the  con- 
sequence. In  this  opinion,  however,  I  am  not  sustained 
by  the  weight  of  medical  authority. 

Treatment. — When  called  to  a  case  of  this  character, 
you  will  generally  find  it  obstructed,  and  your  great 
effort  will  be  to  produce  free  evacuation  as  soon  as  pos- 
sible, and  for  this  object  I  will  recommend  various 
remedies  that  I  have  used  with  success.  If,  after  you 
have  tried  castor  oil,  infusion  of  senna  and  sails  or  pills 
of  aloes  and  colocynth  with  no  advantage,  you  will  have 


CONSTIPATION. 


307 


to  try  podophyllin,  croton  oil,  elaterium,  &c,  with  the 
addition  of  turpentine  enema  and  cold  water. 

I  generally  use  the  castor  oil  as  follows :  take  castor 
oil  1  pint,  oils  of  wintergreen  and  origanum  aa.  g  ss. 
Shake  well,  and  give  two  table-spoonsful  every  two 
hours.  Beach's  composition  powder  of  senna  is  a  valu- 
able hydragogue  cathartic,  it  is,  senna  1  lb.,  jalap  i  lb., 
cloves,  ginger  or  spearmint,  2  ounces,  finely  pulverized 
together ;  I  generally  add  five  grains  of  cayenne  pepper 
to  each  dose ;  it  is  given  in  doses  of  from  one  to  two 
drachms,  sweetened  in  water.  The  following  cathartic  I 
have  used  with  decided  effect  in  severe  cases.  Take 

1^.    Podophyllin,       grs.  x.  (mandrake.) 
Leptandrine,  (black  root.) 

White  sugar,  3iss. 

Mix  intimately,  give  from  five  to  ten  grains  every 
two  hours,  until  free  catharsis  is  produced. 

Aloes,  rhubarb  and  soap,  is  a  favorite  remedy  with 
many,  but  I  prefer,  the  following : 

ty.  Pulv.  Aloes. 
Assafoetidse. 
Soap,  aa.  5L 

Beat  with  water  to  form  a  mass,  divide  into  forty  pills, 
give  from  three  to  five. 

When  the  constipation  is  very  obstinate,  either  of  the 
following  recipes  can  be  relied  on : 

^.    Elaterium,  grs.  vi. 
Ext.  of  gentian. 
Soap,  aa.   grs.  ix. 

Mix.  Divide  into  twelve  pills.  Give  from  one  to  four. 


308 


CONSTIPATION. 


1} .    Tartarized  sodae,  Si. 

Ext.  henbane,  grs.  vi. 

Syrup  of  chamomile,  fl.  Si. 
Water,  Svi. 

Mix.    A  spoonful  every  hour. 

When  there  is  a  tendency  to  habitual  costiveness  I 
generally  prescribe  the  annexed  mixture  : 

^.    Sulphate  of  soda,  5xiv. 

Acetate  of  potassa,  grs.  xxv. 

Nitre,  31. 

Tartar  emetic,  gr.  ss. 

Water,  pints,  2}. 

Dissolve,  and  filter.    Give  wine-glassful. 
The  following  has  considerable  reputation  as  a  laxa- 
tive in  constipation : 

1^.    Flower  of  sulphur,  3ii. 
Cream  tartar,  3vi. 
Powdered  fennel  seed, .  3i. 
Sugar,  Sss. 

Mix.    A  tea-spoonful  two  or  three  times  a  day. 

In  very  severe  and  obstinate  cases  I  generally  resort  to 

^.    Croton  oil,  gtts.  ii. 

Mucilage  gum  arabic. 
Distilled  water,  aa.  Si- 

Mix,  and  give  a  tea-spoonful  every  two  hours  until  it 
operates.  We  assist  in  relieving  the  bowels  by.  either 
of  the  following  enemas  : 

Acetic  acid,  from  one  to  three  oz. 
Barley  water,  gvi,  or 

Venice  turpentine,  Sss. 


CONSTIPATION. 


309 


Yolk  of  one  egg. 
Infusion  of  flaxseed,  gx. 
Linseed  oil,  gi. 

Mix,  and  inject. 

We  have  frequently  relieved  the  patient  by  simple 
cold  water  injections.  The  extract  of  butternut,  buck- 
bean,  and  ox  gall  are  valuable  remedies,  the  latter  I 
think  particularly  so. 

After  you  have  succeed  in  removing  the  faeces,  you 
must  not  continue  your  active  cathartics,  for  the  system 
soon  becomes  habituated  to  their  use,  they  must  be  dis- 
pensed with  if  possible.  When  the  individual  is  disposed 
to  constipation  and  torpor  of  the  intestines,  a  daily  aloetic 
pill,  with  cold  water  enema  at  night,  which  should  be 
retained,  will  generally  afford  relief,  if  accompanied  with 
appropriate  regimen. 

Eecently  the  "  ox  gall  has  been  strongly  advised  as  a 
direct  solvent  to  accumulated  hardened  fasces,  the  con- 
sequence of  deficiency  of  quality  or  quantity  of  bile  in 
the  alimentary  canal."  The  following  is  the  mode  in 
which  to  administer  it.  Take 

Inspissated  ox  gall,  3ii 
Oil  carui,  (caraway)  gtts.  x. 
Carb.  magnesia,  q.  s. 

Divide  into  thirty-six  pills,  give  two,  three  or  four 
times  a-day 

"  A  most  important  assistance  to  the  remedy  as  above 
mentioned  is  the  proper  adaptation  of  diet  and  exercise. 
By  simply  eating  bran  bread,  or  bread  made  of  unbolted 
flour,  or  corn  bread,  ripe  fruit,  or  preserves,  figs,  stewed 
prunes,  or  a  free  use  of  molasses by  these  means  the 


310 


DYSENTERY. 


bowels  may  sometimes  be  kept  entirely  soluble  in  con- 
stipated habits,  without  the  use  of  any  cathartic. 
Regular  exercise  on  foot  is  the  most  preferable. 

DYSENTERY. 

This  is  an  acute  inflammation  of  the  mucous  mem- 
brane of  (either  the  whole  or  a  portion)  of  the  alimeu- 
tary  canal ;  and  a  disease  that  is  becoming  quite  preva- 
lent in  this  climate. 

When  the  inflammation  is  seated  on  the  upper  bowels, 
your  patient  will  complain  of  a  bitter  taste,  the  appetite 
weak,  and  the  tongue  covered  with  a  whitish  fur ;  urine 
high  colored. 

If  the  small  intestines  should  be  involved  in  the  in- 
flammation, the  tongue  will  present  a  brown  fur,  and 
the  edges  very  red ;  the  stools  only  mucous ;  some  irri- 
tability of  the  stomach,  and  pain  under  pressure. 

If  the  inflammation  is  chiefly  confined  to  the  lower 
bowels,  you  will  have  it  accompanied  with  great  pain, 
frequent  desire  to  go  to  stool,  with  mucous  and  bloody 
discharges,  terminating  in  what  is  frequently  called 
bloody  flux. 

Symptoms. — There  is  almost  a  constant  desire  to  go 
to  stool,  accompanied  with  the  most  excruciating  pains, 
especially  in  the  colon  and  rectum.  Sometimes  it  makes 
its  appearance  suddenly,  with  griping  mucous  and  bloody 
stools^  without  the  least  premonitory  symptom.  In 
general,  the  fever  is  developed  before  these  symptoms 
present.  There  is  little  or  no  fasces  discharged  during 
the  disease,  and  the  violence  of  the  pain  affords  a  good 
diagnosis  as  to  the  degree  and  danger  to  be  apprehended. 

In  protracted  and  violent  cases,  great  prostration  en- 


DYSENTERY. 


311 


sues,  and  frequently  preceded  by  a  colliquative  perspi- 
ration, which  is  indicative  of  great  danger. 

The  urine  is  always  scanty  and  high  colored,  and  the 
functions  of  the  skin  and  liver  are  invariably  disordered, 
in  regard  to  perspiration  and  biliary  secretion. 

Causes. — Among  the  sporadic  causes  of  dysentery, 
may  be  mentioned  the  immoderate  use  of  green  fruit, 
indigestible,  unwholesome  and  irritating  food  of  all 
kinds ;  drastic  cathartics,  vicissitudes  of  temperature 
and  obstructed  perspiration,  and  ill  ventilated  apartments. 

I  am  under  the  impression  that  cold,  or  sudden  varia- 
tions of  atmospheric  temperature  and  humidity,  must 
operate  in  conjunction  with  other  general  causes  of  an 
occult  character,  before  the  disease  can  become  exten- 
sively prevalent. 

Treatment. — In  the  treatment  of  this  disease,  I  differ 
widely  from  most  of  my  medical  brethren,  but  I  can 
assure  you,  if  my  treatment  is  followed,  you  will  save, 
when  the  opposite  treatment  might  prove  the  reverse. 
I  generally  commence  the  treatment,  and  at  almost  any 
stage,  by  opening  the  bowels  with  the  following  : — 

Podophyllin,         grs.  iv.  (Mandrake) 
Leptandrin,  grs.  hi.    (Black  Eoot.) 

Dover's  powders,    grs.  x. 

Mix,  and  divide  into  four  powders.  Give  one  every 
three  hours,  until  the  bowels  are  freely  moved ;  if  this 
should  not  act  promptly,  I  substitute  for  the  Dover's 
powders,  cream  tartar  9u\,  and  give  as  before  directed, 
alternating  with  the  following  : — 

^.  Ehubarb, 

Bicarbonate  potassa,  aa.  5i. 

Pulv.  Ipecac,  grs.  xh. 


312 


DYSENTERY. 


Mix.  Take  a  tea-spoonful  of  this  mixture,  add  half 
pint  of  boiling  water,  sweeten,  and  give  table-spoonful 
every  hour  or  two.  It  is  only  necessary  to  administer 
these  until  free  catharsis  is  produced ;  so  soon  as  that  is 
established,  commence  giving : 

fy.    Sul.  Quinine,  grs.  xxiv. 

Pulv.  Opii,  grs.  ii. 

"    Ipecac,  grs.  iv. 

Mix,  and  divide  into  eight  powders;  give  one  every 
three  hours. 

If  there  is  great  debility,  you  can  add  capsicum  to 
the  above. 

We  generally  give  the  following,  during  the  whole 


course  of  the  disease : 

Tinct.  kino,  Sss. 

Tinct.  catechu,  5i. 

Comp.  tinct.  opii,  gss. 

Tannin,  grs.  v. 

Vini  ipecac,  3iiss. 
Mucilage  gum  arabic,  Siss. 


Mix.    Give  a  tea-spoonful  every  two  or  three  hours. 

I  assist  the  action  of  the  medicine  in  relieving  the 
disease,  by  giving  the  following  injection  immediately 
after  each  action  from  the  bowels : 

^.    Infus.  hydrastis  can.,  (golden  seal,)  Si- 

Tinct.  opii,  5ss. — Inject. 

If  this  treatment  should  fail  to  relieve  the  tenesmus 
and  bloody  discharges,  as  a  dernier  resort,  I  have  given, 
and  with  good  success,  the  following : 


DYSENTERY. 

fy.    Corrosive  sublimate, 
Pulv.  ipecac., 
"  opii, 

Divide  into  eight  powders ;  give  one  every  three 
hours. 

Where  there  is  great  irritability  of  the  stomach,  to 
relieve-  which  I  apply  poultices  of  wheat  bran  and 
mustard,  stewed  in  hot  vinegar,  to  be  changed  when 
cool,  sometimes  substitute  cloths  wrung  out  of  hot 
brandy,  alternated  with  sinapisms. 

We  frequently  use  the  common  injection  of  Dr. 
Beach,  and  in  violent  cases  have  used  the  following 


with  advantage  : 

R.    Lunar  caustic,  grs.  ii. 

Tinct.  opii,  5ss. 

Water,  5vi. 


Inject  one-fourth  every  hour. 

You  will  frequently  find  cases  that  the  quinine  will 
aggravate  instead  of  benefiting  the  disease,  in  such  cases 
you  can  administer  opium  in  very  large  doses,  with  the 
happiest  and  best  effects;  and  I  have  frequently  com- 
bined with  this  mode  of  treatment  the  saline  cathartics, 
b  with  decided  advantage.  In  connection  with  this,  I 
generally,  if  I  adopt  this  mode,  give  iodine  injections, 
say, 

Iodine,  grs.  v. 

Tinct.  opii,  gtts.  xx. 

Water,  511. 

Inject  two  or  three  times  a-day. 

The  following  is  a  valuable  recipe,  for  children  labor- 
ing under  this  disease : 


grs.  ii. 
grs.  xii. 
grs.  iss. 


313 


DYSENTERY. 


^.    Pulv.  Leptandrin,  (black  root.) 

"     zingiber,  (ginger,)  aa.  grs.  vi. 

"     podophyllin,  (mandrake,)  grs.  iss. 

"     cretse  preparat.  (prep'd  clialk,)  grs.  xii. 

Loaf  sugar,  5ii. 

Mix  intimately,  and  divide  into  ten  powders.  Give 
one  every  three  hours,  to  a  child  from  one  to  four  years 
old. 

.  The  chalk  mixture,  with  the  addition  of  tinct.  kino, 
3-,  in  tea-spoonful  doses,  is  a  good  remedy  for  children. 
Hoj:>e's  mixture  has  also  considerable  reputation,  for  this 
disease  in  children,  it  is  as  follows : 

Ify.    Aquas  Camphorse,  giv. 
Acidi  nitrici,  gtts.  v. 

Tinct.  opii,  Si- 
Mix.    I  give  this  in  tea-spoonful  doses  every  hour. 
I  append  a  variety  of  prescriptions,  which  I  have  used 
in  this  disease,  with  considerable  benefit : 

1^.    Nitric  Acid,  3ii. 

Opium,  grs.  hi. 

Water,  5n\ 

Syrup  of  cinnamon,  Sss. 

Mix.  A  table-spoonful  every  hour,  to  be  given  in 
barley  water. 

^.    Bruised  Ipecac,  3ii. 
Boiling  water,  Sxii. 

One-third  of  the  water  is  to  be  used  at  a  time,  so  as 
to  make  three  decoctions ;  these  are  to  be  united,  and 
should  amount  to  six  ounces — one-third  to  be  taken  at 
a-time.    If  my  memory  serves  me  right,  this  is  the 


DYSENTERY. 


315 


Brazilian  method  of  treating  dysentery,  and  it  is  much 
celebrated  in  the  East. 

I  frequently  use  a  strong  decoction  of  the  bayberry 
root,  and  have  derived  much  advantage  from  it ;  it  is 
highly  extolled. 

We  cannot  too  highly  estimate  the  value  of  podo- 
phyllum ipecac,  and  leptandrin,  as  a  remedy  in  dysen- 
tery ;  give  a  half  grain  of  each  every  three  hours,  until 
it  operates  freely ;  you  will  find  this  a  prompt  and  an 
efficient  remedy. 

A  strong  decoction  of  the  common  nettle  has  been 
advised  in  dysentery,  in  doses  from  two  to  four  ounces. 

Remedies,  sometimes  very  simple  in  their  character, 
frequently  nevertheless  possess  great  virtues  in  certain 
forjns  of  disease,  and  this  cannot  be  more  fully  demon- 
strated, than  to  assure  you  that  salt  and  vinegar  are  in 
some  parts  of  this  union  almost  regarded  as  a  specific, 
for  this  troublesome  as  well  as  dangerous  complaint. 

In  a  conversation  with  my  friend,  Dr.  R.  Baldwin,  of 
Winchester,  Ya.,  a  practitioner  of  extensive  reputation 
and  character,  he  assured  me  that  he  has  given  a  tea- 
spoonful  of  salt  and  a  table-spoonful  of  vinegar,  repeat- 
ing it  every  hour  or  two,  and  derived  more  benefit  from 
it  in  dysentery,  than  from  any  other  remedy  he  ever 
used.  It  was  communicated  to  him  by  Dr.  Tucker,  of 
Richmond,  who,  if  I  am  correctly  informed,  has  a  high 
opinion  of  its  value  in  this  class  of  diseases. 

Such  authority  is  sufficient  for  the  profession  to  test 
fully  its  merits. 

The  diet  must  be  confined  to  the  mildest  kind  of  food, 
such  as  barley  water,  farina,  and  I  particularly  recom- 
mend the  following: 


316 


DIARRHOEA. 


fy.  .  Starch,  5vi. 
Water,  lbs.  vi. 

Boil  till  reduced  to  three  pounds,  and  add, 

Wine  giv. 
Lemon  juice,  gi. 
Simple  syrup,  gii. 
Mix  and  permit  to  cool.    Or  the  following, 

^    Sheep  suet  gii. 
Milk,  pint,  i. 

Starch,  gss. 


Boil  slowly  for  half  an  hour.  Use  in  small  quanti- 
ties. 

In  the  chronic  form  of  this  disease,  the  above  will  be 
the  proper  diet;  and  the  preparations  of  strychnine  will 
generally  give  prompt  relief. 

DIARRHOEA. 

Diarrhcva  differs  from  dysentery  in  the  peculiar  char- 
acter of  the  alvine  discharges ;  it  is  true  they  are  liquid 
and  frequent,  but  they  are  not  dysenteric  in  their  char- 
acter. 

Symptom*. — A  frequent  desire  to  stool,  evacuations 
generally  watery,  and  if  it  is  the  result  of  acid  or  unwhol- 
some  food,  the  discharges  present  a  buffy  appearance; 
it  is  seldom  attended  with  any  pain.  Every  possible 
diversity,  however,  exists  in  the  degree,  duration  and 
danger  of  the  complaint. 

Treatment. — Your  first  object  must  be  to  ascertain  the 
cause,  to  inspect  the  evacuations,  and  your  treatment 
must  vary  according  to  the  character  of  the  disease.  If 
it  is  the  result  of  irritant  substances  in  the  alimentary 


DIARRHCEA. 


317 


canal,  a  brisk  cathartic  should  be  administered.  If  the 
stools  are  yellow  or  green,  or  you  have  any  indications 
that  it  is  the  result  of  generated  acid  in  the  alimentary 
canal,  we  would  advise  an  alkali.  In  such  cases  we 
frequently  use  the  chalk  mixture,  with  the  addition  of 
tinct.  kino. 

If  you  are  satisfied,  from  the  evacuations,  that  the 
secretions  from  the  liver  are  in  a  manner  suspended,  you 
will  find  the  preparations  of  podophyllin  and  leptandrin, 
given  in  small  doses,  well  calculated  to  arouse  that 
organ  to  action,  and  establish  a  normal  condition  of  it. 

After  the  administration  of  the  podophyllin,  we  gene- 
rally give  the  following : 

3^.    Tannic  acid,         grs.  xii. 
Syru}3  of  rhatany, 

"      "  gum,      aa.  Si. 
Camphor  water,  Biv. 
Mix,  and  give  a  tea-spoonful  every  hour. 

To  correct  the  secretions  when  the  diarrhcea  is  the 
result  of  acid  generated  in  the  primae  viae,  (intestines,) 
I  generally  administer  the  following: 


fy.    Prepared  chalk,  5ii. 

Loaf  sugar  and  gum  arabic,  aa.  q.  s. 

Oil  of  cinnamon,  gtts.  hi. 

Tinct.  opii.  5i. 

"     kino,  5ii. 

"     catechu,  5L 

Distilled  water,  giv. 


Mix,  and  give  a  table-spoonful  every  two  hours.  Or 

Beach's  Neutralizing  Mixture,  which  speedily  arrests 
this  variety.    It  is  as  follows : 


318 


DIARRIKEA. 


fy.    Rhubarb,  pulv., 
Saleratus,  pulv., 

Peppermint  plant,  pulv.,  equal  parts. 
To  a  large  tea-spoonful  add  half-pint  of  boiling  water ; 
w  hen  cool,  strain,  sweeten  with  loaf  sugar,  and  add  a 
table-spoonfnl  of  brandy.    Dose. — Table-spoonful  or  two, 
according  to  circumstances. 

In  the  diarrhoea  of  children  we  frequently  use  the 
above;  but  an  excellent  remedy  is  powdered  charcoal 
and  magnesia,  given  in  tea-spoonful  doses, 

If  the  disease  is  obstinate  in  its  character,  and  does 
not  readily  yield,  you  can  administer  the  following : 

fy.    Sul.  of  copper,  (green  vitriol,)  grs.  x. 
Pulv.  opium,  grs.  iv. 

Armenian  bole, 

Catechu,  aa.  9iss. 

Divide  into  20  pills,  give  one  every  twro  or  three 
hours,  suspending  all  other  remedies. 

This  should  be  followed  by  the  following  injection : 

^.    Bistort,  Si. 
Poppyheads,  5ii. 

Water,  one  pint.    Infuse  and  strain. 

The  rvbus  villosus  (blackberry)  has  long  occupied  the 
confidence  of  medical  men  in  bowel  affections.  The 
best  preparation  is  to  take 

Small  roots  of  blackberry,  Bi. 
Water,  a  pint  and  a  half. 
Boil  down  to  a  pint  and  strain. 
Dose  one  or  two  ounces,  three  or  four  times  a  day. 


CHOLERA  MORBUS. 


319 


The  following  syrup  is  highly  recommended  by  Dr. 
Beach  and  others,  in  the  chronic  form  of  this  disease, 
either  in  children  or  adults. 

Take  two  quarts  of  ripe  blackberries,  add  one  pound 
of  loaf  sugar,  half  an  ounce  of  nutmeg,  half  an  ounce  of 
cinnamon,  quarter  of  an  ounce  of  cloves,  with  the  same 
amount  of  allspice ;  boil  altogether  for  a  short  time,  and 
when  cold,  add  one  pint  of  good  French  brandy.  After 
standing  for  a  few  days  in  a  close  vessel  or  bottle,  it 
may  be  strained.  This  makes  a  pleasant  syrup.  Dose 
from  a  tea-spoonful  to  a  wine  glass  full,  according  to 
age,  three  or  four  times  a  day. 

In  that  variety  of  diarrhoea,  accompanied  with  pain, 
Hunn's  drops  will  afford  the  most  speedy  relief ;  it  is 
composed  of  equal  parts  of  oils  of  cajeput,  cloves,  pep- 
permint, and  anise,  each  one  ounce ;  rectified  alcohol, 
four  ounces. 

Dose  from  one  to  two  drachms,  in  hot  brandy  and  water, 
sweetened,  or  in  simple  syrup,  or  mucilage  of  slippery 
elm. 

CHOLERA  MORBUS. 

Cholera  morbus,  like  diarrhoea  and  dysentery,  is  a 
disease  of  the  stomach  and  intestines,  and  the  symptoms 
which  characterize  it  are  closely  allied  to  diarrhoea,  with 
this  difference  only,  that  there  is  severe  vomiting,  ac- 
companied with  griping  pains  in  the  region  of  the  sto- 
mach, frequently  very  intense. 

Causes. — The  principal  one,  in  my  opinion,  is  irritat- 
ing and  indigestible  food.  Fruits  of  almost  any  variety 
run  into  a  state  of  fermentation,  and  generate  in  the 
stomach  and  bowels  a  superabundance  of  acid,  which 


320 


CHOLERA  MORBUS. 


lias  a  great  tendency  to  produce  irritation  of  the  mucous 
membrane  of  the  whole  alimentary  canal. 

Symptoms. — The  premonitory  symptoms  are  heart- 
burn, and  eructations  of  an  acid  character,  which  are  soon 
followed  by  vomiting  and  purging,  accompanied  with 
the  most  excruciating  pain,  which  is  at  times  peculiarly 
severe  in  the  umbilical  region  (navel).  As  the  disease 
advances,  the  pulse  sinks,  the  blood  recedes  from  the 
surface,  the  extremities  become  cold,  a  clammy  perspi- 
ration follows,  terminating  in  hiccough  and  cramps,  and 
unless  reaction  is  speedily  produced,  will  in  many  cases, 
especially  in  feeble  constitutions,  terminate  fatally. 

Treatment. — Your  first  object  will  be  to  administer 
such  remedies  as  will  neutralize  the  acid,  which,  in  my 
opinion,  is  almost  the  universal  cause  of  the  disease ;  the 
remedy  that  will  fulfil  this  indication  to  your  satisfac- 
tion, is  Beach's  Neutralizing  Mixture,  (see  prescription 
under  the  head  of  diarrhoea.)  I  generally  combine  with 
each  dose  about  one  fourth  of  a  grain  of  morphine,  and 
administer  two  table-spoonfuls  of  the  mixture  at  least 
every  half  hour.  I  frequently  alternate  this  with  the 
chalk  mixture.  Should  the  symptoms  not  be  subdued 
under  this  treatment,  and  there  should  be  evident  pros- 
tration, I  give  small  portions  of  brandy  in  combination 
with  capsicum  occasionally,  and  prescribe  a  mucilaginous 
injection,  with  at  least  a  tea-spoonful  of  the  bicarbonate 
of  potash,  and  the  same  amount  of  laudanum  to  be  used 
with  it.  Warm  fomentations  to  the  abdomen  will 
generally  allay  pain  and  remove  the  cramps ;  for  this 
purpose  hops  dipped  in  hot  vinegar  will  answer  well. 

Hunn's  drops,  of  which  we  have  already  had  occasion 
to  allude,  will  be  found  of  great  advantage  in  controlling 
the  discharges.    (See  Diarrhoea.) 


CHOLERA. 


321 


ASIATIC  CHOLERA. 

I  shall  not  attempt  a  detailed  statement  in  reference 
to  the  history,  causes,  nature  and  character  of  this 
disease;  but  I  shall  premise  by  saying  that,  so  far  as  I 
have  noticed  it  in  this  city,  it  has  not  altogether  exhib- 
ited that  uniformity  in  the  peculiarity  of  its  symptoms 
which  has  been  ascribed  to  it  in  many  other  places. 
The  premonitory  symptoms  that  I  have  observed  here, 
begin  with  soreness,  pain,  distention  and  flatulency  in 
the  stomach  and  bowels ;  this  is  soon  followed  by  a  fre- 
quent, violent  vomiting  and  purging  of  bilious  matter, 
with  severe  tormina,  heat,  thirst,  and  a  hurried  respira- 
tion. There  soon  follows  great  depression  of  strength, 
with  cold  clammy  perspiration,  cramp  of  the  extremi- 
ties, with  a  sinking  and  irregular  pulse,  the  countenance 
becomes  hippocratic,  the  color  of  the  skin  of  a  pur- 
ple tinge;  collapse  follows,  which  quickly  terminates  in 
death. 

It  is  true  that  diarrhoea,  nausea  and  vomiting  were 
the  marked  symptoms  in  a  very  large  proportion  of  the 
cases,  but  there  were  some  cases  without  any  nausea  or 
vomiting. 

Pathology. — I  wish  to  call  your  attention  to  one  fact 
in  relation  to  its  pathology.  Post-mortem  examinations 
reveal  the  true  changes  which  take  place  during  the 
disease;  and  it  is  these  changes  that  should  be  well 
observed  and  remembered,  as  they  are  sure  guides  in  the 
treatment. 

The  only  morbid  change  which  is  developed,  upon 
post-mortem  examination,  is  congestion.  "In  96  cases 
examined  by  Drs.  Parkes  and  Massie,  nearly  every 
organ  was  congested." 

Treatment. — In  the  Eclectic  Medical  Journal  of  April, 

21 


322 


CHOLERA. 


1849,  I  published  an  article  upon  the  treatment  of  this 
disease.  Then,  as  now,  I  called  the  attention  of  the 
profession  to  the  pathology  of  the  disease,  and  showed 
that  it  had  a  strong  analogy  to  congestive  fever,  from 
the  fact  that  in  both  diseases  the  blt)od  recedes  from 
the  surface,  and  congests  itself  in  and  upon  the  inter- 
nal organs.  Now,  any  remedy  that  would  have 
a  tendency  to  produce  re-action  in  one,  would  most 
likely  be  followed  by  the  same  results  in  the  other; 
consequently  I  contend  that  the  cold  dash,  which  is  so 
universally  acknowledged  in  congestive  fever  as  the  most 
efficient  remedy  to  produce  reaction,  will,  if  given  in 
time,  be  followed  with  like  results  in  cholera.  The 
great  misfortune  has  been,  that  this  remedy  has  been 
looked  upon  as  a  dernier  resort,  and  the  time  for  its 
administration  is  postponed  to  that  period  when  proba- 
bly nothing  could  be  used  that  would  effect  any  good. 
I  believe  I  was  the  first  to  suggest  this  remedy,  and  I 
am  from  experience  satisfied  that  it  is  the  great  sheet 
anchor  in  producing  reaction. 

I  am  not  so  bigoted  or  so  wedded  to  any  system  of 
medicine  as  to  be  its  champion  to  the  exclusion  of  others. 
I  consider  I  have  a  perfect  right  to  investigate  all  of  the 
different  systems,  and  avail  myself  of  any  information 
which  I  may  deem  important  and  true;  and  I  will  pre- 
mise by  saying,  that  the  treatment  I  adopt  now  for 
cholera,  has  been  attended  with  more  success  than  when 
I  treated  it  under  different  systems. 

Your  treatment  will  have  to  be  regulated  by  the  con- 
dition of  your  patient  at  the  time  you  are  called  in,  and 
one  leading  indication  will  be,  in  either  the  confirmed 
or  collapsed  stage,  to  establish  reaction,  and  produce  a 
determination  to  the  surface,  inducing  perspiration, 


CHOLERA. 


323 


If  I  am  called  at  an  early  period  of  the  disease,  even 
when  there  is  nausea,  vomiting  and  diarrhoea,  I  com- 
mence the  treatment  by  giving  equal  parts  of  rhubarb 
root,  pulverized  saleratus,  and  peppermint  plant  pow- 
dered— one  pinft  of  boiling  water  being  added  to  half  an 
ounce  of  this  compound.  After  simmering  it  for  half 
an  hour,  sweeten  with  loaf  sugar  and  strain,  and  when 
nearly  cold,  two  or  three  table-spoonsful  of  good  French 
brandy  should  be  added.  Give  two  table-spoonsful  of 
this,  taken  warm,  in  connexion  with  the  following  pre- 
paration, viz  : — 

1^.  Pulverized  cinnamon,  cloves,  and  gum  guaiacum 
each  1  oz.,  good  brandy  1  quart,  given  in  two  tea-spoons- 
ful to  a  table-spoonful  every  fifteen  or  twenty  minutes, 
to  an  adult. 

The  patient  should  be  well  covered  with  warm 
clothing,  and  bottles  of  hot  water,  bricks  and  stones 
placed  around  his  body.  This  course  is  almost  sure  to 
be  followed  by  a  moderate  moisture  of  the  skin,  which 
should  be  kept  up  for  eight  or  ten  hours ;  to  do  which 
I  give  ptisan  of  catnip  or  spearmint,  and  apply  hot 
tincture  of  cayenne,  by  flannel  cloths  over  the  abdomen ; 
if  this  fails  to  keep  up  the  perspiration,  I  administer 
the  following,  viz : 

I^.    Camphor,  grs.  x. 

Ipecac,  grs.  v. 

Opium,  grs.  iiss. 

Super  carbonate  of  soda,  sii. 

Mix,  and  divide  into  two  or  three  powders ;  give  one 
every  hour,  or  oftener.  In  those  cases  however,  which 
are  marked  by  violent  vomiting  and  purging,  from  the 
commencement  of  the  disease,  and  which  have  not 


324 


CHOLERA. 


already  passed  into  the  stage  of  collapse ;  or  if  this  train 
of  symptoms  are  present  at  the  time  I  am  called  to  the 
patient,  whether  the  attack  commenced  with  them  or 
not ;  in  th.e  stage  of  collapse,  or  that  stage  approaching 
to  it,  I  then  commence  the  treatment  with  the  cold  dash. 
Strip  the  patient — I  generally  make  the  assistants  hold 
him  up — turn  from  five  to  fifteen  buckets  of  cold  water 
upon  him,  in  quick  and  rapid  succession ;  immediately 
wrap  him  up,  without  wiping,  in  a  hot  blanket ;  apply 
bottles  of  hot  water  and  hot  bricks  all  round  him ;  im- 
merse his  feet  in  a  hot  ley  bath,  and  if  the  vomiting  has 
not  ceased,  assist  its  action,  by  giving  the  following  com- 
pound : — Take  of  the  saturated  acetous  tincture  of  san- 
guinaria  canadensis,  (blood  root),  of  lobelia  inflata, 
tinctured  in  the  same  manner,  in  vinegar,  and  spiritous 
tincture  of  the  aralia  spinosa,  (Southern  prickly  ash), 
equal  parts,  and  give  it  in  doses  of  from  one  to  two 
table-spoonsful  or  more,  mixed  in  warm  water,  or  catnip 
tea,  every  ten  minutes,  until  vomiting  is  freely  pro- 
duced. 

The  simple  prescription  of  salt,  pepper  and  vinegar 
generally  acts  promptly.  Your  most  urgent  indication 
will  be,  as  I  have  heretofore  said,  to  produce  an  equi- 
librium in  the  circulation,  the  compound  tincture  of 
guaiacum,  as  suggested-  before,  is  a  valuable  recipe  to 
fulfil  this  indication,  and  in  very  urgent  cases,  I  have 
used  tincture  of  camphor,  Siv.,  essence  of  peppermint, 
5iv.,  syrup  of  ginger,  gss.,  tincture  of  cayenne,  5i.  A 
table-spoonful,  from  one  to  four  in  an  hour. 

I  have  given  the  saturated  tincture  of  prickly  ash, 
with  the  compound  tincture  of  guaiacum,  with  good 
effect,  in  doses  from  a  tea-spoonful  to  a  table-spoonful 
every  fifteen  or  twenty  minutes.    When  there  is  exces- 


CnOLERA. 


325 


sive  irritability  of  the  stomach,  the  following  injection 
should  be  given  after  every  discharge.    Take — 

Saturated  tincture  of  prickly  ash,  3ss. 


In  a  case  or  two  of  collapse  which  I  treated,  after  the 
cold  dash  I  applied  blankets  over  the  whole  body,  as 
hot  as  could  be  handled,  after  dipping  them  in  boiling 
water,  removing  and  replacing  every  fifteen  or  twenty 
minutes,  which  I  have  no  doubt  assisted  the  reaction. 
In  connection  with  this  I  gave  a  preparation  composed 
of  equal  parts  of  the  oils  of  peppermint,  cloved,  anise, 
cajeput,  with  half  of  the  whole  amount  of  alcohol,  given 
in  a  tea-spoonful  every  ten  or  fifteen  minutes  in  a  glass 
of  hot  brand}'  toddy. 

"  Whatever  may  be  given  by  the  mouth  or  in  the 
form  of  injection,  you  must  not  forget  to  put  in  requi- 
sition the  whole  train  of  external  excitants,  sinapisms 
over  the  bowels  and  spine,  cold  dash,  hot  bricks,  &c," 
and  I  am  fully  under  the  impression  that  it  is  best  to 
try  and  establish  the  reaction  before  you  commence 
giving  any  remed}'  of  a  stimulating  character,  especially 
when  there  is  active  congestion. 

The  following  is  a  prescription  that  is  highly  extolled, 
viz : 


Mix,  and  divide  into  four  parts,  one  to  be  taken  every 
two  hours.    In  our  hands  this- recipe  has  never  met  our 


"Water, 

Tincture  opii, 


^.    Calomel,  31. 


Opium,  gr.  i. 

SugarofLead,  grs.  v. 
Cayenne,        grs.  vi. 


326 


CHOLERA. 


expectations,  and  although  I  am  aware  that  the  advo- 
cates of  this  administer  the  calomel  with  the  view  of 
restoring  the  secretions,  I  am  satisfied  from  my  experi- 
ence in  cholera  that  it  fails  to  do  this ;  the  lead,  I  think, 
exerts  too  depressing  an  influence  in  this  disease  when 
reaction  is  established ;  by  substituting  quinine  for  the 
lead,  I  would  have  no  doubt  that  it  would  be  a  valuable 
remedy. 

Dr.  Hempel,  a  homoeopathic  physician,  speaks  in  high 
terms  of  the  spirits  of  camphor,  ipecac,  veratrum  and 
cuprum.  I  have  used  the  tincture  of  aconite,  ten 
drops  to  ten  spoonsful  of  water,  and  given  two  tea- 
spoonsful  every  five  minutes,  I  think,  with  some  advan- 
tage ;  the  veratrum  and  cuprum,  may,  and  I  think  will 
arrest  the  discharges  in  rfery  mild  cases.  But,  in  short, 
the  homoeopathic  treatment  will  not  do  to  rely  on  in 
cholera. 

Dr.  Bird,  and  Professors  Herrick  and  Blany,  extol 
sulphur  as  a  specific  in  this  disease ;  this  is  strong  lan- 
guage ;  they  say,  "  so  far  as  its  efficacy  has  been  tested  in 
the  worst  stages  of  collapse,  most  satisfactory  results  have 
been  obtained.  In  two  or  three  cases  of  the  kind,  the 
effect  of  the  remedy  has  been  to  bring  back  pulse  to  the 
wrist,  restore  warmth  to  the  surface,  and  stop  the  pro- 
fuse diarrhoea  and  vomiting.  In  truth,  the  results  ob- 
tained so  far,  have  been  such  as  to  convince  all  of  us 
who  have  administered  it  and  witnessed  its  effects,  that 
if  any  remedy  deserves  the  appellation,  this  is  the  spe- 
cific^ in  cholera."  They  give  four  or  five  grains  every 
three  or  four  hours. 

The  following  remedies  have  a  weight  of  testimony 
in  their  favor  that  entitle  them  to  consideration,  viz : 
Nitric  acid,  fl.       opium,  grs.  ii,  syrup  of  cinnamon,  gss, 


CHOLERA. 


327 


water,  3ii.  •  Mix.  A  table-spoonful  every  hour  in  barley 
water. 

A  liniment,  which  is  used  as  a  rubefacient  in  cholera, 

.1^.    Nitric  acid,  gii. 

Oil  of  turpentine,  Biii. 

Theriac  honey,*  5i. 

Alcohol,  Svi. 

To  be  freely  applied  to  the  surface. 

^.    Subnitrate  of  bismuth,  grs.  vih.  (purified  bismuth.) 
Opium,  gr.  i. 

Sugar,  3ii. 

Mix,  and  divide  into  four  powders.  Much  praised 
in  cholera,  one  to  be  taken  every  two  hours. 

1^.  Dried  hemp  tops,  any  quantity ;  boil  in  alcohol 
until  all  the  resinous  matter  is  dissolved.  Stram,  and 
evaporate  to  proper  consistence. 

Dr.  O'Shaughnessy  speaks  in  high  terms  of  this  in 
ten  grain  doses,  to  be  increased  as  occasion  may  require. 

1^.    Acetate  of  lead,  9i. 
Opium,  gr.  i. 
Conserve  . of  roses,  q,  s. 

Mix.    Divide  into  'twelve  pills.    One  every  hour  at 


*  If  this  is  the  remedy  that  holds  its  place  in  the  Codex  of  the  Fa- 
culte  de  Medicine  of  Paris,  it  will  be  difficult  to  procure it  was  origi- 
nally composed  of  sixty-one  ingredients,  and  they  have  since  added  an 
additional  number ;  it  would  not  do  for  me  to  say  that  this  is  discredit- 
able to  the  profession,  as  that  which  is  foreign  has  heretofore  been 
highly  appreciated  by  Americans. 


328 


CHOLERA. 


first,  then  every  two  hours.  A  favorite  of  Dr.  Graves 
of  London. 

fy.    Chlorate  of  potassa,  grs.  vh. 

Muriate  of  soda  (common  salt),  9i. 
Carbonate  of  soda,  3ss. 
Mix,  and  give  for  a  dose.    It  is  highly  recommended. 

Ity.    Bicarbonate  of  potassa,  grs.  x  to  xv. 
Mint  water,  gvi. 
Dissolve. — A  spoonful  every  hour.    This  is  highly 
spoken  of. 

The  following  plaster  has  a  weight  of  testimony  in  its 
favor,  which  inclines  me  to  the  opinion  that  it  is  a  valu- 
able agent. 

fy.    Simple  plaster,  3vi. 
Resin,  3ii. 
Melt  together,  and  add : 

Sulphate  of  quinine,  3i- 
Oil  of  cajeput. 
Camphor,  aa.<*  9i. 
Mix. — This  to  be  applied  over  the  stomach. 

Prof.  R.  S.  Newton  says,  he  has  cured  several  cases 
of  cholera,  in  the  collapsed  stage,  by  giving  doses  of  ten 
to  fifteen  grains  of  tannin,  every  ien  or  fifteen  minutes, 
until  the  discharges  ceased,  and  continuing  it  afterwards 
at  longer  intervals,  with  other  treatment. 

The  prickly  ash  (I  mean  the  Xanthoxylon  Fraxin- 
lurn,  not  the  toothache  tree)  has  been  extolled,  and 
deservedly  so,  in  this  disease.  It  was  extensively  used 
by  the  eclectic  physicians  of  Cincinnati,  and  with  great 
success — it  acted  like  electricity,  so  sudden  was  its  in- 


CHOLERA  INFANTUM. 


329 


fluence  over  the  system ;  indeed,  many  patients  likened 
its  action  to  an  electric  shock,  which  seemed  to  diffuse 
itself  throughout  the  whole  frame.  We  gave  it  in  tea- 
spoonful  doses,  slightly  diluted,  and  repeated,  according 
to  circumstances,  every  five,  ten,  or  fifteen  minutes, 
with  a  stimulating  injection,  to  be  given  immediately 
after  each  discharge  from  the  bowels,  and  retained  by 
the  patient  as  long  as  possible.  This  is  one  of  our  most 
valuable  agents.  Dose  of  the  tincture  of  the  berries,  as 
a  carminative  and  antispasmodic,  ten  to  thirty  drops, 
three  or  four  times  a  clay.  Used  by  some  during  the 
intermissions,  as  a  remedy  in  intermittent  fever,  which 
it  is  said  to  remove  speedily.  There  is  a  material  dif- 
ference, in  their  influence  on  the  system,  between  the 
tincture  of  the  bark  or  that  of  the  berries,  which  should 
always  be  had  in  view.  A  patient  with  cholerine  came 
very  near  losing  life,  in  consequence  of  using  the  tinc- 
ture of  the  bark  instead  of  the  berries,  as  prescribed ; 
the  druggist  who  filled  the  prescription  supposed  the 
properties  of  each  were  similar,  and  that  they  could  be 
safely  substituted  the  on%  for  the  other. 

During  the  cholera  of  '49,  '50,  '51,  Hunn's  Drops  were 
used  extensively  by  eclectics.  There  is  no  question  but 
that  it  is  an  invaluable -remedy,  and  should  be  kept  by 
every  physician,  druggist,  and  family.  For  its  recipe, 
see  diarrhoea. 

CHOLERA  INFANTUM. 

This  disease  is  always  febrile,  accompanied  with  more 
or  less  diarrhoea,  before  the  vomiting  commences ;  it  is 
one  of  the  most  fatal  to  which  children  are  liable. 

Symptoms. — It  is  almost  exclusively  confined  to  cities, 


330 


CIIOLERA  INFANTUM. 


it  is  a  rare  disease  in  the  country.  Some  authors  attri- 
bute it  to.  the  irritation  of  dentition,  and  contend  that 
that  is  the  principal  cause  of  this  affection.  There  must 
be  some  others,  from  the  fact  that  the  disease  seldom 
appears  in  the  county.  It  may  be  the  impure  air  of 
cities  (see  our  article  on  yellow  fever),  by  which  the 
infantile  system  is  rendered  irritable,,  and  peculiarly 
predisposed  to  suffer  disturbance  from  the  irritation  of 
of  dentition. 

The  evacuations  are  generally  devoid  of  bilious  mat- 
ter. It  assumes  soon  a  chronic  form,  which  speedily 
creates  great  weakness,  emaciation,  and  prostration. 
The  disease  seems  to  affect  the  brain ;  in  this  variety 
insensibility  and  coma  soon  follow.  The  pulse  is  fre- 
quent and  tense ;  sometimes  griping  pain,  increased 
on  pressure.  When  the  disease  has  progressed  some 
time  you  have  aphtha?,  and  very  frequently  a  cankerous 
mouth. 

Treatment. — Your  first  indication  is  to  remove  the 
causes.  With  a  proper  attention  to  diet  and  clothing, 
with  a  change  of  atmosphere,  yciur  patient  will  generally 
recover  without  the  aid  of  medicine.  It  is  only  where 
the  complaint  is  of  long  standing,  or  where  there  is  evi- 
dent inflammation,  that  medical  treatment  is  essentially 
necessary.  The  clothing  should  be  of  that  character, 
as  not  to  oppress  the  child,  but  to  preserve  an  equal 
temperature  of  the  body.  When  treatment  is  essential, 
I  generally  give  a  diaphoretic  to  produce  a  gentle  per- 
spiration, followed  by  laxatives  and  antacids  generally, 
to  remove  the  irritation  from  the  alimentary  canal.  If 
tl^e  liver  is  torpid,  the  secretions  must  be  established ; 
and  if  there  should  be  excessive  evacuations,  you  must 
arrest  them  by  astringents.    The  gums  if  inflamed 


CHOLERA  INFANTUM. 


331 


should  be  freely  scarified,  and  blisters  are  highly  ex- 
tolled ;  they  should  be  placed  behind  the  ears. 

If  there  should  be  excessive  vomiting,  apply  a  mus- 
tard plaster  to  the  stomach ;  if  there  should  be  much 
fever,  give  an  infusion  of  benne  leaves,  or  a  small  por- 
tion of  Dover's  powders.  "Whatever  fluid  is  used,  must 
be  in  very  small  quantities,  -so  as  not  to  irritate  the 
stomach.  To  arouse  the  secretions  of  the  liver,  if  they 
are  suspended,  we  give  the  following  : — 

^.    Podophyllin,  gr.  i. 

Opium,  gr.  i. 

Acetate  of  lead,  gr.  i. 

Mix,  and  divide  into  eight  powders.  Give  one  every 
two  hours.  If  there  should  be  excessive  evacuations, 
we  generally  give  either  of  the  following : — Sheep's 
suet,  Sii. ;  milk,  1  pint ;  starch,  gss.  Boil  slowly  for 
an  half  hour,  and  give  it  in  small  quantities  at  a  time; 
or,  make  an  emulsion^  take  of  poppy  £ss. ;  argillae,  pure, 
;  syrup  althcea,  gss.  Mix,  and  give  in  doses  of  a 
tea-spoonful. 

When  the  irritability  of  the  stomach  ceases,  it  will  be 
necessary  to  administer,  in  addition  to  the  podophyllin, 
remedies  to  evacuate  the  bowels ;  for  this  purpose,  rhu- 
barb and  magnesia  are  well  adapted.  I  have  frequently 
usei,  with  the  most  beneficial  results,  mercury  and 
chalk,  and  this  is  peculiarly  applicable  when  the  sto- 
mach is  irritated  and  the  secretion  of  bile  deficient. 

In  obstinate  cases,  and  where  there  was  excessive  dis- 
charges, I  have  administered  Hope's  mixture  with 
decided  benefit.    The  following  is  the  recipe,  viz  : 

Camphor  water,  giv.  * 

Nitric  acid,  gtts.  iv. 

Laudanum,  9ii. 


332 


COLICA. 


Mix,  and  give  half  tea-spoonful  every  hour  or  two. 
(If  the  nitric  acid  is  added  in  larger  proportion,  it  is 
liable  to  defeat  the  object  of  the  prescription.) 

To  arrest  the  vomiting,  if  the  mustard  plaster  fails,  I 
generally  use  a  clyster  of  five  or  six  drops  of  laudanum 
in  thin  starch.  You  will  find  this  useful  throughout 
the  complaint. 

The  diet  should  be  either  fresh  cow's  milk,  diluted 
with  water,  or  any  of  the  farinaceous  liquids,  prepared 
from  parclied  rice,  sago,  or  arrow  root. 

We  have  had  occasion  to  allude  to  the  leaves  of  rasp- 
berry, in  decoction  with  cream,  as  beneficial  in  allaying 
nausea ;  and  if  you  combine  it  with  aromatics,  you  will 
find  it  a  good  remedy  in  cholera  infantum. 

The  common  nettle  is  a  well  known  plant,  and  a 
strong  syrup  made  of  the  root,  combined  with  suitable 
quantities  of  wild  cherry  bark  and  blackberry  root,  forms 
an  excellent  remedy  for  all  summer  complaints  of  chil- 
dren. 

Dose  of  this  decoction  from  a  drachm  ^°Jp  ounce. 
COLICA. 

Colic  has  some  analogy  to  enteritis,  (inflammation  of 
the  bowels,)  but  there  is  one  prominent  system  that 
will  aid  you  in  a  diagnosis.  Pressure  gives  ease  in  colic 
and  increases  the  pain  in  every  description  of  intestinal 
inflammation. 

There  are  different  varieties  of  colic,  arising  from 
different  causes,  such  as  nervous  and  bilious  colic,  flatu- 
lent and  lead  colic,  the  latter  a  very  painful  and  dan- 
gerous disease ;  every  variety  is  generally  attended  with 
costiveness  and  severe  pain  of  the  bowels. 

When  colic  arises  from  indigestion,  the  preparation 


COLIC. 


of  rhubarb  and  magnesia,  with  a  small  portion  of  mor- 
phine, will  give  speedy  relief. 

Flatulent  Colic  frequently  arises  from  obstructed  per- 
spiration, but  most  commonly  from  vegetables,  which, 
from  indigestion  ferment. 

Treatment. — Hot  brand}'  sling,  strongly  impregnated 
with  any  of  the  aromatic  substances,  generally  gives 
relief.  I  frequently  use  raw  brandy  and  camphor.  You 
will  meet  cases,  however,  where  this  will  fail ;  you  will 
then  apply  warm  fomentations  to  the  abdomen,  and 
give  either  of  the  following,  viz  : 

Wormwood,  tansy,  centaury,  bog  bean,  equal  parts ; 
pure  brandy,  one  hundred  and  fifty  parts,  and  carbonate 
of  potash  one  part ;  digest  and  filter.  Give  one  or  two 
drachms,  according  to  circumstances.  Or,  give  Dewees' 
Carminative — ^.  Carbonate  of  magnesia,  5ss. ;  tincture 
of  assafoetidce,  5i. ;  tincture  opium,  5ss. ;  sugar,  5i. ; 
water,  5i.  This  can  be  given  to  an  adult  for  a  dose,  but 
to  infants,  fifteen  or  twenty  drops  at  a  time. 

Frequently,  friction  over  the  region  of  the  navel,  has 
a  tendency  to  cause  the  gas  to  escape.  The  tinctures 
of  the  berries  of  the  Southern  prickly  ash  has  been 
advantageous  hi  violent  colic. 

Hunn's  drops  are  valuable  in  colic.     (See  Diarrhoea.) 

Bilious  Colic  is  generally  the  result  of  long  continued 
constipation,  and  this,  in  my  opinion,  is  the  result  of 
torpidity  of  the  liver,  it  not  secreting  bile  in  sufficient 
quantities,  which  is  the  natural  stimulus  for  the  healthy 
action  of  the  intestines.  Constipation,  or  its  opposite, 
frequently  ensues;  some  contend,  however,  that  it  is 
from  a  redundancy  of  bile.  I  am  strengthened  in  my 
opinion,  from  the  fact  that  it  is  generally  extremely 


334 


COLIC. 


difficult  to  produce  bilious  discharges,  and  when  once 
established,  the  patient  is  comparatively  relieved. 

Symptoms.  —  There  is  generally  great  irritability  of 
the  stomach,  a  bitter  taste  and  great  heat,  attended 
with  very  acute  pains  about  the  region  of  the  navel, 
shifting  frequently  to  various  parts  of  the  abdomen,  and 
generally  little  or  no  discharge  of  urine. 

Treatment. — To  allay^the  vomiting,  I  give  a  drop  of 
kreosote,  if  this  does  not  have  the  desired  effect,  I 
generally  give  a  table-spoonful  of  the  neutralizing  mix- 
ture, as  recommended  in  cholera,  at  least  every  half 
hour.  To  relieve  the  bowels  and  arouse  the  secretions 
of  the  liver,  I  give  the  following : 

^.  Aloes,  5i.,  gamboge  and  extract  of  eupatorium 
perfoliatum,  (boneset,)  3ss.,  castile  soap,  9i.,  extract 
podophyllum,  lobelia  seeds  pulverized,  and  extract 
gentian,  aa.  9i.,  capsicum  x.  grs.,  oil  of  cloves,  gtts.  4. 
Warm  the  extracts  until  they  are  soft,  add  the  other 
articles  in  fine  powder,  mix  intimately  and  divide 
into  5  gr.  pills,  as  an  active  cathartic,  give  from  four 
to  six.  . 

You  will  find  cases  where  the  pain  is  so  acute, 
that  you  will  have  to  use  anodynes  from  the  com- 
mencement. In  such  cases  I  give  morphine,  until  I 
allay  the  irritation ;  before  I  give  the  cathartic  pills, 
their  action  should  be  assisted  by  stimulating  ene- 
mas, and  where  there  is  much  pain,  two  or  three 
scruples  of  laudanum  can  be  added  to  the  injections 
with  advantage. 

Where  the  disease  is  very  violent  in  its  character, 
the  warm  bath  should  be  resorted  to,  in  connection  with 
the  other  remedies. 


COLIC. 


335 


Let  your  enemas  be  composed  of  salts  and  opium, 
or  oil  and  turpentine.  Fomentations  of  hops  in  hot 
vinegar,  should  be  applied  to  the  abdomen. 

The  Dioscorea  Villora,  (mild  yam,)  has  been  success- 
fully used  in  bilious  colic,  in  doses  of  half  a  pint  at  a 
time. 

PAINTERS'  COLIC. 

This  species  of  colic  especially,  in  regard  to  the  se- 
verity of  symptoms,  differs  materially  from  the  other 
varieties. 

Symptoms. — Violent  pain  at  the  pit  of  the  stomach,  a 
hard  and  quick  pulse,  excessive  thirst,  violent  constipa- 
tion, frequent  desire  to  stool,  without  being  able  to 
evacuate  anything ;  a  frequent  vomiting,  the  muscles  of 
the  abdomen  seem  to  contract  into  knots..  Painters' 
colic  exhibits  an  example  of  slow  poisoning,  it  is  pro- 
duced in  lead  mines  and  lead  works,  and  painters  and 
glaziers  are  particularly  liable  to  it,  by  inhalation,  and 
not  unfrequently  by  drinking  water  impregnated  with 
lead.  The  metal  being  introduced  into  the  system  in  a 
soluble  form,  makes  its  way  elsewhere  among  the  tis- 
sues, and  lays  the  foundation  of  chronic  and  frequently 
returning  pains. 

Treatment.  —  Diluted  sulphuric  acid  or  sulphuretted 
waters,  render  lead  insoluble  in  water,  whether  in  the 
body  or  out  of  it,  and  they  have  therefore  be?n  pre- 
scribed as  the  standard  remedies  for  painters'  colic. 
Observation,  however,  has  shown  these  remedies,  though 
they  assuage  or  remove  the  symptoms  of  the  disease, 
still  leave  the  lead,  (which  caused  it)  diffused  in  an 
inert  state  through  the  body,  ready,  when  favorable 
conditions   arise,  again  to  act  injuriously  on  bodily 


336 


painters'  colic. 


health.  Mr.  Melsen,  I  think,  has  perfected  this  subdi- 
vision of  chemical  physiology,  and  has  pointed  out  the 
means  both  of  detecting  the  lurking  presence  of  the 
metal  in  the  system,  and  of  entirely  expelling  it  as  a 
cause  of  disease.  A  substance  known  in  chemistry, 
under  the  name  of  Iodide  of  Potassium,  is  capable  of 
decomposing  the  insoluble  compound  of  lead,  and  of 
bringing  the  metal  into  a  new  condition,  in  which  it 
readily  dissolves  in  water.  If  the  system  is  impreg- 
nated with  lead,  there  will  be  an  effort  on  the  part  of 
nature  to  throw  it  off ;  'the  metal  makes  its  way  through 
the  kidneys,  and  can  be  detected  in  the  urine.  Now, 
if  you  cure  by  sulphuric  acid  or  sulphuretted  water, 
with  the  pain  the  lead  disappears  from  the  urine, 
but  remains  in  the  system,  give  a  dose  of  the  iodide 
of  potassium,  and  the  pains  of  poisoning  return,  and 
lead  reappears  in  the  urine.  A  large  dose  will  prostrate 
again  with  colic,  but  small  doses  at  frequent  intervals, 
will  gradually  cleanse  the  system  of  the  lead,  without 
any  sensible  suffering. 

You  have  here  a  remedy  that  is  a  specific  for  painter's 
colic,  when  caused  from  lead.  Its  value  will  be  appre- 
ciated in  this  disease,  as  well  as  in  salivation. 

You  will  find  cases  where  the  pain  is  so  violent  you 
will  have  to  resort  to  remedies  to  allay  the  irritation. 
For  this  purpose  I  frequently  give  the  extract  of  bella- 
donna in  large  doses,  and  have  administered,  in  this  form 
of  colic  as  well  as  spasmodic,  chloriform,  in  increasing 
doses,  from  20  to  140  drops,  in  the  twenty-four  hours, 
with  the  happiest  effect. 

Dr.  Hester,  of  New  Orleans,  advises  the  sulphate  of 
alumina,  from  one  to  two  drachm  doses,  and  has  seen 
the  most  complete  success  in  more  than  one  instance. 


CONSTIPATED  COLIC. 


337 


I  have  given  croton  oil  in  combination  with  hyosci- 
amns  or  belladonna,  in  drop  doses,  and  it  answers  well 
in  either  combination  to  allay  irritability  and  produce 
evacuations. 

In  violent  cases  the  treatment  of  this  variety  is  nearly 
the  same  as  in  bilious  colic.  Your  main  reliance,  to 
effect  a  permanent  cure,  is  on  the  iodide  of  potassium. 

Letters  on  Constipated  Colic,  vulgarly  called  Patent-Dry- 

Belhj'Ache. 

We  have  received  from  a  friend  the  manuscript  copies 
of  two  letters  upon  this  subject,  from  the  pens  of  Dr.  A. 
Smith  and  Dr.  Bowers.  It  is  with  pleasure  that  I  insert 
them  in  my  work,  together  with  the  notice  of  the  editor 
of  the  New  Orleans  Medical  Journal.  I  have  never 
met  a  case  of  the  character,  and  am  really  thankful  to 
my  friend  for  the  MSS. 

"  The  following  communications  have  been  kindly 
transmitted  to  the  editor  by  Dr.  Ashbell  Smith,  of  Galves- 
ton, Texas,  describing  a  peculiar  affection,  vulgarly  called 
"patent-dry-belly-ache,"  but  the  physicians  designate  it 
"constipated  colic."  One  of  these  letters  was  addressed 
to  Dr.  Smith  by  Dr.  Bowers,  of  Brazos  Santiago,  in 
answer  to  some  inquiries  of  the  former  gentleman 
addressed  to  the  latter.  Both  these  letters  will  be  found 
highly  interesting,  and  we  invite  the  attention  of  the 
reader  to  the  subject." 

Galveston,  Texas,  March  I0t7i,  1849. 

Mr  Dear  Dr.  : — 

In  the  summer  of  1847,  there  prevailed  in  Galveston, 
an  epidemic  colic,  which  went  by  the  common  name  of 
patent-belly-ache ;  whence  or  why  it  took  the  epithet, 
"patent,"  I  cannot  conjecture.    It  proved  fatal  to  three 
22 


338 


CONSTIPATED  COLIC. 


of  the  oldest  residents  of  the  City,  perhaps  to  others, 
about  whom  I  have  no  information. 

I  did  not  see  either  of  the  three  cases  alluded  to 
above,  but  was  told  by  the  medical  gentlemen  attending 
them,  that  after  an  illness  of  a  few  days,  the  fatal  ter- 
mination took  place  very  suddenly.  A  post-mortem 
examination  of  one  of  the  cases  was  made,  at  which  I 
assisted.  Owing  to  the  heat  and  disagreeable  odor  ex- 
haled from  the  corpse  it  was  very  incomplete ;  moreover, 
the  notes  which  I  took  have  been  misplaced  in  the  con- 
fusion of  my  papers,  by  reason  of  a  fire  which  occurred 
on  the  lot  adjoining  me  a  few  days  since.  I  can,  how- 
ever, state  from  memory,  that  the  omentum  was  entirely 
infected,  glued  in  some  two  or  three  points  to  the  intes- 
tines, and  that  in  these  points  the  intestines  were  ulcer- 
ated and  perforated.  The  perforations  were  from  a  half 
line  to  two  or  three  lines  in  diameter,  and  smeared 
about  their  edges  with  thick  green  pus.  The  examin- 
ation was  so  imperfect  that  I  will  not  attempt,  especially 
in  the  absence  of  my  notes,  to  speak  of  the  mucous  coat 
of  the  alimentary  canal,  nor  even  to  decide  whether  the 
ulceration  commenced  on  the  mucous  or  serous  surface 
of  the  intestines.  The  perforation,  however,  appears  to 
me  to  explain  the  suddenness  of  the  death  in  the  case 
examined,  and  I  incline  to  think  that  a  like  phenome- 
non took  place  in  the  other  suddenly  fatal  cases. 

I  had  several  cases  in  my  practice,  but  I  shall  not 
attempt  to  describe  minutely  the  disease.  The  promi- 
nent symptoms,  as  presented  to  me,  were  severe  abdom- 
inal pains,  with  most  obstinate  constipation;  to  these  were 
very  uniformly  joined,  general  uneasiness,  more  or  less 
anxiety,  and  great  muscular  prostration.  The  disease 
was  seldom  accompanied  with  fever.    The  symptoms 


CONSTIPATED  COLIC. 


339 


subsided,  and  the  patient  became  convalescent,  on 
obtaining  free,  copious,  fsccal  and  bilious  discharges.  I 
still  entertain  doubt  whether  such  discharges  are  to  be 
regarded  as  the  cause,  or  an  effect  of  the  solution  of  the 
disease.  Sometimes  the  disease  subsided  so  suddenly 
and  completely,  that  I  suspected  an  intus-susception 
suddenly  restored ;  if  there  existed  intus-susception,  it 
was  without  strangulation. 

The  most  successful  treatment  here,  according  to  my 
observation,  consisted  jn  free  cupping  over  the  abdomen, 
general  bleeding,  calomel  and  opium,  succeeded  by  cas- 
tor oil,  and  oil  of  turpentine  and  warm  bath. 

For  a  much  better  account  of  the  symptomatology 
and  details  of  treatment  of  this  disease,  I  beg  to  refer  to 
the  accompanying  letter  of  the  judicious  Dr.  Bowers,  of 
Brazos  Santiago. 

As  to  the  causes  of  this  disease,  I  am  quite  in  the 
dark.  It  appears  to  me  to  be  obviously  allied  to  the 
colics  which  have  prevailed  at  various  times  in  different 
parts  of  the  world,  and  received  names  either  from  their 
localities  or  from  their  supposed  causes;  still  the  "patent 
belly-ache,"  or  "  constipated  colic"  of  the  coast  of  Texas, 
has  relations  to  another  disease  of  importance  prevailing 
occasionally  in  this  region,  to  which  relations  I  shall 
draw  your  notice  briefly  before  closing  this  letter.  To 
return  to  the  causes :  Dr.  John  Taylor,  a  skilful  practi- 
tioner of  this  city,  attributes  the  colic  in  question  to  the 
excessive  use  of  ice  water  as  a  beverage.  The  vicissi- 
tudes of  heat  and  cold,  in  what  way  soever  produced, 
perhaps  sometimes  a  hot  mid-day  sun,  with  cool  and 
humid  nights,  seem  to  me  to  be  among  the  probable 
assignable  causes;  and,  according  to  my  recollection, 


340 


CONSTIPATED  COLIC. 


Baron  Larrey  has  attributed  a  somewhat  similar  colic 
epidemic  to  such  vicissitudes. 

What  relationship  or  resemblance  has  the  Texas  colic 
in  question  to  the  dry-belly-ache  of  the  West  Indies  ? 
I  never  saw  the  dry-belly-ache  of  the  West  Indies,  nor 
can  I  now  investigate  the  matter  by  reference  to  books. 

I  have  stated  that  the  patent-belly-ache  prevailed 
here  in  1847;  it  was  succeeded  by  epidemic  yellow  fever, 
the  latter  epidemic  seeming  to  take  the  place  of  the 
former. 

I  was  absent  from  home  during  the  hot  season  of  last 
year,  1848,  but  I  am  certainly  informed  that  the  patent- 
belly-ache  or  constipated  colic  prevailed  here  during  the 
last  hot  season,  the  summer  and  autumn  of  1848,  and 
that  it  was  succeeded  and  appeared  to  be  displaced  by 
the  yellow  fever,  in  the  same  manner  as  happened  the 
preceding  year.  I  may  here  state  that  the  number  of 
cases  of  yellow  fever  in  this  city  last  year  was  very 
small,  owing,  perhaps,  in  a  great  measure,  to  the  small 
number  of  unacclimated  persons. 

Mentioning  these  facts  to  Dr.  John  H.  Bowers,  of 
Brazos  Santiago,  he  informed  me,  that  during  the  hot 
season  of  1848,  a  constipated  colic,  like  that  which  I 
have  attempted  imperfectly  to  describe,  prevailed  as  an 
epidemic  at  Brazos  Santiago ;  that  it  was  suddenly  dis- 
placed or  superceded  by  epidemic  yellow  fever;  that 
after  a  period,  yellow  fever  wholly  disappeared,  and  the 
constipated  colic  or  patent-belly-ache  resumed  its  reign. 

I  begged  Dr.  Bowers  to  draw  me  up  an  account  of 
these  facts,  and  of  the  colic  in  question,  which  he  has 
obligingly  done.  I  have  taken  on  myself  the  liberty  of 
transmitting  his  communication  to  you,  thinking  that 
his  facts  possess  interest  for  the  medical  public,  and 


COXSTIPATED  COLIC. 


341 


that  you  may  deem  them  worthy  of  a  place  in  your 
journal.  From  an  acquaintance  of  many  years  with 
Dr.  JBowerSj  I  esteem  him  an  accurate  observer  and  very 
skilful  practitioner,  indeed,  in  the  experience  and  treat- 
ment of  the  diseases  of  our  climate,  I  do  not  know  that 
he  is  surpassed. 

I  sat  down  to  write  a  few  words  explanatory  of  the 
accompanying  letter  of  Dr.  Bowers,  they  have  extended 
to  a  I0112;  letter,  vet  I  find  on  looking  over  what  I  have 
written  that  what  I  have  stated  would  be  incomplete 
without  a  few  additional  remarks. 

I  am  not  aware  that  a  constipated  colic  or  the  patent- 
belly-ache  has  prevailed  at  Galveston  previously  to  1847. 
Galveston  was  commenced  to  be  built  in  the  spring  of 
1838 ;  in  the  autumn  of  IS 39  it  was  ravaged  by  yellow 
fever,  it  then  contained  about  2,500  inhabitants. 
Whether  that  epidemic  was  preceded  by  any  other 
disease  cannot  now  be  certainly  ascertained.  I  did  not 
take  up  my  residence  in  Galveston  until  about  a  week 
previously  to  the  appearance  of  the  yellow  fever  that 
year.  I  have  not  spent  an  entire  hot  season  in  Galves- 
ton since  1841,  with  the  single  exception  of  the  year 
1847;  but  on  inquiring  of  others  I  cannot  learn  of  the 
existence  of  the  "  colic"  previously  to  1847 ;  since  the 
settlement  of  Galveston  to  the  present  time,  yellow  fever 
has  prevailed  in  1839, 1844, 1847,  and  1848,  in  this  city. 

I  have  not  intended  to  intimate  the  opinion  that  the 
"  colic"  and  yellow  fever  have  any  relation  to  or  con- 
nection with  each  other,  much  less  would  I  intimate 
that  they  are  different  forms  of  the  same  disease.  I 
only  give  the  facts  and  coincidences  for  what  they  are 
worth. 

I  remain,  yours,  &c, 

ASHBELL  SMITH. 


342 


CONSTIPATED  COLIC. 


The  following  is  the  letter  of  Dr.  Bowers,  referred  to 
by  Dr.  Smith : 

Galveston  Bay,  Texas,  January  30,  1849. 
My  Dear  Doctor, — 

I  write  you  a  few  hurried  lines  in  answer  to  your 
request,  regarding  the  diseases  which  prevailed  on 
Brazos  Santiago,  in  the  course  of  last  summer,  and  only 
premise  it  with  the  remark,  that  I  write  entirely  from 
memory,  my  time,  during  the  season,  having  been  so 
occupied,  that  I  could  not  take  any  notes,  being  obliged 
to  be  not  only  both  physician  and  apothecary,  but  in  a 
great  measure  nurse  also. 

I  returned  from  my  visit  to  this  part  of  the  country, 
to  the  Island  of  Brazos  Santiago,  about  the  tenth  day 
of  July,  1848,  and  found  many  persons  sick  with  a 
kind  of  colic,  called  by  the  people  by  the  trite  name  of 
"  patent-belly-ache."  The  symptoms  were  severe  pains 
in  the  abdomen,  which  could  be  partially  relieved  by 
pressure,  obstinate  constipation,  bilious  vomiting,  acid 
eructations,  great  restlessness,  loss  of  appetite,  and  great 
wakefulness — the  patient  being  wholly  deprived  of  sleep. 
In  a  few  of  the  more  severe  cases,  the  nervous  system 
was  more  or  less  implicated,  and  in  every  instance  the 
mind  of  the  patient  was  despondent.  The  pulse  was 
generally  of  the  natural  standard,  but  sometimes  it  was 
full,  hard  and  tense.  In  three  or  four  instances,  there 
was  considerable  fever,  but  most  cases  were  wuthout  any 
general  vascular  excitement;  the  tongue  was  thickly 
covered  with  a  slimy  yellow  or  dark  brown  coat.  The 
most  singular  symptom,  and  the  one  that  struck  me 
most,  was  the  appearance  of  the  eyes,  which  were  red, 
swollen,  and  resembling  those  of  a  drunken  person. 


CONSTIPATED  COLIC. 


343 


In  the  more  aggravated  cases,  the  pains  were  not  con- 
fined to  the  abdomen,  but  extended  to  the  back,  loins, 
arms,  and  soon  to  the  head.  No  fatal  cases  occurred  in 
my  practice,  but  I  frequently  heard  of  persons  dying  of 
the  disease,  both  at  the  Brazos  and  at  the  mouth  of  the 
Rio  Grande.  I  understood  the  disease  prevailed  as 
high  up  the  river  as  Matamoras  and  Brownsville,  where 
some  deaths  occurred.  Relapses  were  very  frequent ;  I 
attended  many  who  suffered  with  it  twice,  and  not  a 
few  three  times.  The  duration  of  the  disease  was  from 
twenty-four  .hours  to  fifteen  days,  but  it  commonly 
yielded  in  four  or  five  days. 

When  called  upon  to  attend  a  case  of  colic,  the  first 
indication  was  to  allay  the  distressing  vomiting,  which 
was  generally  accomplished  by  applying  large  sinapisms 
over  the  stomach,  and  keeping  an  immovable  position 
on  the  back.  I  then  gave  a  mercurial  purge  of  fifteen 
grains  calomel,  with  twenty  of  rhubarb  and  one-quarter 
grain  morphine.  If  the  stomach  rejected  the  medicine, 
I  directed  warm  pediluvium  frequently  repeated,  the 
mustard  plasters  to  be  re-applied ;  injections  of  soap  and 
water  or  salt  and  water  to  be  given  every  half  hour  or 
hour,  and  then  the  calomel,  rhubarb  and  opiate  to  be 
administered  again.  Sometimes  I  had  to  omit  the  rhu- 
barb, as  the  stomach  could  not  be  made  to  retain  it ;  in 
those  cases  the  quantity  of  calomel  was  doubled,  six  or 
eight  hours  following  this,  a  large  dose  of  castor  oil  and 
spirits  turpentine,  or  an  infusion  of  senna,  rhubarb  and 
manna,  with  a  little  sulphate  of  magnesia,  was  ex- 
hibited, but  always  being  careful  to  re-apply  the  mus- 
tard, else  t]*e  stomach  would  reject  the  medicine. 

The  most  potent  remedy,  however,  and  the  one  which 
never  failed  me  in  a  single  instance,  was  blood-letting, 


344 


CONSTIPATED  COLIC. 


employed  ad  deliquium.  I  first  tried  it  in  the  case  of 
a  strong  muscular  German,  whose  pulse  was  very  hard 
and  full,  and  who  had  suffered  from  the  disease  in  its 
most  aggravated  form,  for  seven  or  eight  days,  without 
receiving  the  slightest  benefit  from  the  ordinary  treat- 
ment. I  opened  a  vein  in  his  arm  and  let  the  blood 
out  by  a  large  orifice.  It  took  about  forty  ounces  to 
produce  fainting.  Syncope  removed  the  pain  imme- 
diately and  completely,  and  in  less  than  one  hour  his 
bowels  moved  largely  and  freely.  He  was  de  facto  con- 
valescent. Two  days  after,  he  was  at  his-  usual  work. 
The  success  in  this  instance  was  so  complete,  as  to  in- 
duce me  to  make  further  trials,  and  I  found  that  in 
many  instances,  the  medicines  would  operate  under  the 
lancet  and  before  I  could  tie  up  the  arm ;  in  a  few  other 
cases,  additional  medicines  were  required  after  venesec- 
tion, but  they  were  then  easily  kept  upon  the  stomach, 
and  operated  speedily.  In  every  single  instance,  bleed- 
ing removed  every  vestige  of  pain.  I  never  bled  at  the 
onset  of  the  disease,  as  I  had  but  few  opportunities  of 
seeing  it  in  the  formmg  stage,  and  thought  it  better  to 
exhibit  purgatives  first ;  neither  did  I  bleed  every 
patient,  as  it  seemed  to  me  they  all  would  not  bear  the 
lancet  equally  well.  In  debilitated  subjects,  even  when 
the  pulse  was  rather  full  and  active,  I  preferred  dis- 
pensing with  it,  but  in  robust  plethoric  persons,  I  never 
hesitated  one  moment. 

After  the  disease  had  yielded,  and  the  patient  could 
be  prevailed  upon,  I  gave  quinine.  Five  grains,  twice 
daily,  continued  for  four  or  five  days,  was  thought  suffi- 
cient. It  is  a  singular  fact,  that  of  all  the  persons  who 
took  the  quinine,  but  one,  as  far  as  I  recollect,  suffered 
a  relapse. 


CONSTIPATED  COLIC. 


345 


The  cases  were  very  numerous,  particularly  towards 
the  end  of  July,  and  but  few  persons  escaped  the  dis- 
ease. It  is,  however,  a  singular  fact,  that  masters  of 
vessels  and  their  crews  were  frequently  attacked  with 
the  disease,  as  soon  as  they  came  into  soundings,  and 
were  fairly  in  view  of  the  shores. 

They  came  from  ports  where  the  disease  was  said  not 
to  prevail.  About  the  middle  of  August,  the  colic  epi- 
demic suddenly  ceased,  and  yellow  fever  made  its  ap- 
pearance on  the  island,  which  differed  in  nothing  from 
that  of  the  previous  year,  except  that  most  cases  origi- 
nated on  the  island. 

My  treatment  was  also  unchanged.  I  witnessed^no 
fatal  cases,  though  instances  of  black  vomit  occurred  in 
the  hospital  as  well  as  at  Point  Isabel.  This  yellow 
fever  epidemic,  if  epidemic  it  may  be  called,  as  it  was 
not  near  as  general  as  the  first-mentioned  disease,  lasted 
about  three  weeks,  when  it  disappeared  again,  and  gave 
place  to  the  colic,  which  latter  remained  on  the  island, 
at  the  mouth  of  the  Eio  Grande  and  at  Point  Isabel, 
until  cool  weather  set  in. 

I  never  have  been  able  to  understand  the  cause  of  the 
sudden  cessation  of  the  colic  epidemic,  and  its  giving 
way  to  yellow  fever,  nor  of  the  disappearance  of  yellow 
fever  and  the  re-appearance  of  the  first  disease.  The 
weather  during  the  time  was  fine,  and  without  any 
marked  change.  The  heat  was  rather  greater  than  the 
year  previous,  and  the  weather  more  sultry;  we  also 
had  more  northerly  winds. 

In  September  heavy  gales,  with  rain,  occurred  from 
the  north  and  north-east,  and  the  whole  of  Brazos 
Island  was  several  feet  under  water,  with  the  excep- 
tion of  the  sand  hills. 


346 


CONSTIPATED  COLIC. 


There  were  then  many  cases  of  colic  on  the  island, 
but  still  the  disease  was  on  the  decline.  When  the 
waters  left  the  land,  no  increase  or  diminution  of  the 
disease  took  place,  and  no  change  in  the  type.  I  am 
unable  to  say  whether  persons  arriving  on  the  island 
after  the  storms,  and  who  had  not  been  exposed  to  the 
predisposing  cause  previous  to  them,  suffered  from  an 
attack  of  the  disease ;  but  I  can  bring  no  instance  of 
the  kind  to  my  recollection.  The  last  cases  I  attended, 
occurred  in  November. 

I  report  the  following  as  illustrating  the  nature  and 
treatment  of  this  singular  affection  : 

Case  of  Epidemic  Colic,  with  Spasms. 

Mr.  Gerger,  a  former  United  States  wagon-master, 
called  on  me  in  August,  1849,  for  the  purpose  of  put- 
ting himself  under  my  medical  care,  suffering  with  the 
prevailing  disease,  which  was  called  "patent  belly-ache." 
He  had  but  just  recovered  from  an  attack  of  yellow 
fever,  and  his  skin  was  yet  intensely  yellow.  The 
treatment  differed  in  nothing  from  that  of  other  cases. 
The  second  or  third  day  after  he  was  in  my  charge,  his 
attendant  came  to  me  and  reported  him  dying.  I  found 
him  convulsed  by  spasms,  with  loss  of  consciousness,  for 
which  I  directed  friction  and  some  ordinary  remedies, 
but  left  him  with  the  conviction  that  he  would  die 
during  the  night.  In  the  morning  he  was  still  alive, 
and  rather  better.  The  spasms,  however,  came  on  every 
four  or  five  hours ;  the  mind  never  becoming  rational 
between  the  attacks.  The  original  disease,  colic,  had 
not  yielded,  as  was  evinced  by  the  bilious  vomitings 
and  the  complete  constipation  of  his  bowels,  though  I 
found  it  impossible  to  learn  any  thing  from  the  patient. 


CONSTIPATED  COLIC. 


347 


It  was  also  very  difficult  to  administer  remedies  in  suffi- 
cient quantities,  and  injections,  always  resisted  when 
given,  produced  spasms  and  were  ejected  at  once.  He  was 
also  too  much  debilitated  by  yellow  fever  to  allow  of 
bleeding.  About  the  third  morning  my  servant  called 
me  and  said  that  Mr.  Gerger  was .  dead.  I  went  into 
his  room  to  see,  ?md  found  him  lying  on  his  face  across 
the  floor,  some  four  feet  from  his  bed,  to  all  appearance 
lifeless  •  a  slight  tremor  about  the  heart,  and  the  faint- 
est idea  of  breath,  were  all  the  signs  of  life  I  could  per- 
ceive in  him.  I  had  him  laid  on  his  bed,  covered  him 
with  a  sheet,  had  an  injection  given  him*,  which  was 
retained,  and  had  him  rubbed  with  spirits  of  hartshorne 
and  water,  and  then  left  him,  to  attend  to  the  numerous 
other  cases  I  had,  without  having  the  slightest  hope  of  ever 
seeing  him  alive  again.  On  my  return  to  the  office  some 
six  hours  after,  to  my  unspeakable  surprise  I  found  Mr. 
G.  sitting  in  my  arm  chair,  neatly  dressed  and  shaved, 
and  perfectly  rational.  It  seems  that  an  hour  or  two 
after  I  left  him  his  bowels  suddenly  operated  powerfully, 
and  he  awoke  from  his  stupor,  but  without  knowing 
where  he  was.  The  time  from  the  moment  he  had  the 
first  spasm  until  he  recovered  entirely,  was  a  perfect 
blank  in  his  existence.  It  is,  perhaps,  needless  to  add 
that  he  recovered  speedily  and  perfectly,  and  in  a  few 
days  left  for  Matamoras.  I  forgot  to  mention  the  fact, 
that  but  few  persons  who  suffered  with  the  colic  disease 
took  the  yellow  fever  afterwards,  and  vice  versa,  but 
still  I  recollect  two  instances.  The  first  was  the  Master 
of  a  United  States  tow  steamer,  who  had  an  attack  of 
colic  of  some  four  or  five  days  duration,  from  which  he 
recovered  entirely,  and  who  had  an  attack  of  yellow 
fever  some  six  weeks  afterwards.    The  other  was  a 


348 


CONSTIPATED  COLIC. 


United  States  Wagon-master,  who  had  the  yellow  fever, 
which  was  followed  very  shortly  after  his  recovery  by 
the  most  violent  form  of  colic  that  occurred  on  the 
Island,  and  whose  life  I  despaired  of  for  some  days. 
Both  recovered  their  health  fully. 

I  remain,  dear  Sir,  with  great  respect, 

Your  friend  and  ooedient  servant, 

JOHN  S.  BOWERS. 

Dr.  Ashbell  Smith,  Galveston. 

HEMORRHOIDS. 

There  exists  generally  a  peculiar  physical  temper- 
ament or  hereditary  disposition  in  those  persons  who 
suffer  from  this  affection ;  it  is  true  that  age  and  habits 
of  life  seem  to  favor  its  development. 

They  are,  I  have  no  doubt,  more  frequently  caused  by 
torpidity  of  the  liver,  delaying  the  return  of  the  portal 
blood ;  this  produces  costiveness,  and  the  straining, 
which  naturally  follows,  invites  a  determination  of  the 
blood  to  the  anus,  which  produces  a  varicose  condition 
of  the  veins,  the  blood  becomes  coagulated  in  those 
varicose  enlargements,  and  tumors  of  the  vessel  are  the 
result.  This  affection  seems  to  present  two  varieties, 
viz  :  Those  tumors  which  do  not  bleed  are  most  gene- 
rally distinguished  as  blind  piles,  they  are  usually  out 
of  sight,  within  the  anus,  the  internal  piles  are  fre- 
quently of  very  large  dimensions,  they  are  not  so  liable 
to  injury  or  rupture  as  the  external  tumors,  which  are 
called  bleeding  piles. 

Treatment. — Your  first  object  will  be  to  regulate  the 
bowels,  obviate  costiveness,  this  should  be  done  by  laxa- 
tives and  a  due  course  of  regimen,  and  should  be  pursued 
in  either  species,  whether  bleeding  or  blind  ;  to  a  sue- 


PILES. 


349 


cessful  treatment  of  this  disease,  much  depends  upon  the 
general  health.  Hardened  faeces  have  been  frequently 
regarded  as  the  cause  of  this  disease,  but  as  I  before 
observed,  you  will  generally  find  a  torpid  condition  of 
the  liver,  accompanied  with  derangement  of  the  digestive 
organs.  Frequently  the  parts  become  very  much  in- 
flamed; when  such  is  the  case  the  bowels  should  be 
kept  in  a  free  soluble  condition,  and  for  this  purpose  I 
generally  administer  the  following,  so  as  to  arouse  the 
liver  to  speedy  action,  say,  from  an  eighth  to  a  quarter 
of  a  grain  podophyllin  every. two  or  three  hours,  until 
the  secretion  from  that  organ  is  established,  then  to 
fulfil  the  indication  of  keeping  the  bowels  in  a  •  soluble 
condition,  I  give 

Sublimed  sulphur,  Siss. 

Confection  sennoa,  gii. 

Nitre,  3ih\ 

Syrupi  auranto,  (syrup  of  orange  peel)  q.  s. 

Make  a  confection,  and  give  one  or  two  drachms  a 
day,  or  as  circumstances  may  require. 

You  should  also  apply  local  applications  to  allay  in- 
flammation, and  for  this  purpose  I  frequently  use  a 
small  cigar,  moisten  it  in  warm  water^  and  introduce  it 
in  the  rectum,  it  is  a  most  excellent  remedy.  A  local 
application  of  pul.  slippery  elm  will  frequently  relieve 
the  intense  inflammation;  after  the  inflammation  is 
subdued  I  have  used  the  following  applications,  either 
of  which,  if  persevered  in,  will,  in  a  large  majority 
of  cases,  give  relief. 

^.    Extract  of  stramonium,  (Jamestown  weed.) 
Extract  of  tobacco,  aa.  5i. 
Tannin,  grs.  v. 


350 


PILES. 


This  should  be  intimately  mixed,  and  applied  four  or 
five  times  a  day  to  every  tumor,  and  spread  on  a  thin 
cloth  and  applied  at  night ;  when  there  is  any  bleeding 
increase  the  tannin,  or  take  "  a  small  paper  of  cut  to- 
bacco and  put  in  a  frying  pan,  burn  it  to  ashes,  and  add 
hog's  lard."  I  also  add  belladonna,  and  have  found  this 
prescription  to  answer  well  if  applied  three  or  four  times 
a  day. 

I  frequently  use  pulverized  alum  and  the  white  of  an 
egg,  this  will  give  relief  when  there  is  inflammation. 

If  the  disease  is  of  long  standing,  I  direct  the  follow- 
ing alterative  syrup  to  be  taken,  viz : 

Stillingia,  I  lb.  (Queen's  root.) 

Corydallis,  Sii. 

Ampelopsis,  Siii. 

Iris,  versic,  Si-  (Blue  flag.) 

Podophyllin,  grs.  viii. 

Mix,  and  make  a  quart  of  syrup.  Dose,  one  tea- 
spoonful  three  times  a  day. 

Cold  water  and  alum  and  water  are  both  good  local 
applications.  Your  great  object  must  be  to  keep  the 
bowels  in  a  soluble  condition ;  no  treatment  will  be  of 
the  least  advantage  if  this  is  neglected;  and  if  the 
bowels  are  suffered  to  become  constipated  before  you 
complete  the  cure,  the  piles  will  certainly  return. 

There  is  a  variety  that  very  frequently  becomes  cal- 
lous, here  you  will  have  to  use  the  ligature,  pass  it 
through  a  piece  of  spunk,  and  apply  to  the  tumor, 
tighten  it  every  day ;  it  is  simple,  and  no  danger  is  to 
be  apprehended  from  removing  the  tumors  in  this  way. 
I  have  succeeded  in  relieving  such  cases  by  applying  the 
caustic  potash  or  nitric  acid. 


FALLING  OF  THE  FUNDAMENT. 


351 


PROLAPSUS  ANI. 
(falling  of  the  fundament.) 

This  disease  frequently  produces  piles,  and  I  have,  in 
some  instances,  seen  them  in  connection. 

The  bowel  frequently  protrudes,  and  is  sometimes 
suffered  to  remain  until  it  becomes  so  inflamed  and 
swollen,  that  it  is  with  great  difficulty  replaced.  I 
have  seen  cases  where  it  would  have  been  unsafe  to 
attempt  to  replace  it.  In  such  cases,  use  local  fomen- 
tations to  the  part ;  cloths  simply  wrung  out  of  warm 
water  are  very  good ;  apply  until  the  parts  become  soft, 
then  lubricate  the  protruded  portion  well  with  linseed 
oil,  and  replace  it  with  your  fingers  by  gentle  pressure. 
After  which  confine  the  patient  to  his  back,  and  use 
weak  injections  of  the  sugar  of  lead  and  water;  or  you 
can  substitute  for  this  injection  a  strong  decoction  of 
white  oak  bark. 

The  same  constitutional  treatment  as  that  recom- 
mended for  piles  will  be  necessary.  He  should  wear  a 
"  T."  bandage,  and  use  the  pile  ointment. 

On  going  to  stool,  he  should  have  it  so  arranged  that 
his  hips  would  be  considerably  higher  than  his  knees, 
and  he  should  avoid  straining  as  much  as  possible. 

In  cases  of  this  character,  linseed  oil  is  highly  recom- 
mended as  an  aperient;  if  it  should  produce  griping, 
you  can  combine  oil  of  anise,  sassafras,  or  paregoric. 

You  must  sustain  the  general  health,  and  let  the 
patient  make  free  use  of  cold  water  externally. 


352 


THRUSH. 


DISEASES  OF  THE  MOUTH  AND  THROAT, 

APHTHA— THKUSH. 

In  general,  these  two  terms  are  recognised  as  the 
same  disease.  I  am  of  the  opinion  that  they  are  entirely 
distinct,  and  should  not  be  assimilated  together. 

Thrush  is  most  generally  confined  to  early  infancy. 
Inflammation  of  the  mucous  membrane  of  the  mouth  is 
first  observed,  which  in  a  short  period  present  white 
papilla?,  (pimples,)  which  soon  becomes  confluent,  and 
generally  involves  the  whole  mouth,  and  sometimes  ex- 
tends to  the  fauces  and  as  far  as  the  pharynx ;  it  is  gene- 
rally attended  with  diarrhoea,  and  very  frequently  with 
colic.  In  case  of  extreme  duration,  it  has  been  known 
to  involve  the  whole  alimentary  canal.  When  this  is  the 
case,  you  will  find  it  very  difficult  of  cure ;  but  when 
the  inflammation  is  confined  to  the  mouth  only,  it  is 
easily  -  controlled. 

Treatment. — Your  first  object  will  be  to  ascertain  the 
condition  of  the  bowels.  If  they  should  be  constipated, 
or  if  there  be  diarrhoea,  the  result  of  acidities  of  the 
stomach,  I  generally  administer  two  or  three  grains  of 
hydrg.  cum  cretae,  (mercury  and  chalk,)  repeating  it 
every  three  or  four  hours ;  if  there  be  fever,  I  generally 
combine  rhubarb,  and  very  frequently  use  rhubarb  and 
magnesia  alone — fifteen  grains  of  the  former  to  a  half 
drachm  of  the  latter,  dividing  it  into  six  doses. 

The  mouth  should  be  kept  perfectly  clean,  by  fre- 
quently using  an  infusion  of  flax-seed  or  a  solution  of 
gum  Arabic.  Various  detergent  applications  have  been 
advised,  such  as  borax  dissolved  in  honey,  and  Van 
Sweeten  recommends  an  emulsion  of  cream,  yolk  of 


APHTHA. 


353 


eggs,  and  syrup  of  poppies.  In  the  advanced  stages, 
Doctor  Wood  recommends  a  solution  of  sulphate  of 
zinc,  (white  vitriol,)  in  the  proportion  of  two  grains  or 
more  to  the  ounce  of  water.  In  the  same  stage,  rose 
water,  acidulated  with  muriatic  or  sulphuric  acid,  and 
solutions  of  alum,  chlorinated  soda  and  lunar  caustic, 
are  also  occasionally  used.  These  applications  should 
be  pencilled  on  with  a  camel's  hair  pencil,  some  eight  or 
ten  times  a  day. 

I  have  used  the  following  remedies,  and  from  my 
experience  with  them,  I  am  satisfied  they  will  fulfil 
your  expectations.  Make  a  decoction  of  goldthread 
sage  and  hysop,  sweeten  it  with  honey;  a  little  borax 
may  be  added ;  wash  the  mouth  often.  I  frequently 
administer  an  infusion  of  goldthread,  say  §i.  put  into  a 
pint  of  boiling  water ;  infuse  for  an  hour,  and  strain. 
Give  half  a  fluid  drachm. 

If  the  attack  is  malignant  in  its  character,  you  should 
administer  quinine  or  salacine,  (the  willow  oak  bark,) 
in  grain  doses,  with  two  drops  of  muriatic  acid ;  this 
can  be  given  three  or  four  times  a  day. 

Aphthcp. — The  marked  distinction  between  aphthae 
and  thrush  is,  whilst  the  former  is  attended  with  papilla? 
and  inflammation,  it  never  terminates  hi  ulceration ;  the 
latter  (ulceration)  is  always  the  most  prominent  symptom 
in  apthae.  When  the  vesicles  first  make  their  appear- 
ance, they  contain  a  serous  fluid;  in  a  few  clays  they 
break,  and  small  ulcers,  with  a  high  grade  of  inflam- 
mation surround  them.  It  attacks  equally  children 
and  adults ;  and  it  is  different  from  thrush  in  another 
respect,  namely,  not  common  in  early  infancy. 

Treatment. — The  treatment  recommended  in  thrush, 
will  relieve  in  ordinary  cases ;  astringent  applications 
23 


354 


APHTHJE. 


are  indicated  to  heal  the  ulceration ;  and  if  those  recom- 
mended in  thrush  fail,  I  have  frequently  used  effectually 
strong  ^solutions  of  the  nitrate  of  silver,  (lunar  caustic,) 
or  sulphate  of  copper  (copperas.) 

In  the  confluent  variety,  when  the  ulcerations  coalesce 
and  run  together,  and  which  generally  is  severe  and 
obstinate,  from  the  fact  that  it  extends  into  the  fauces 
and  pharynx,  and  renders  deglutition  extremely  painful. 
In  this  form  I  have  used  the  following  recipes,  with  de- 
cided advantage,  viz : — 

3^.    Kreasote,  5ss. 
Powdered  gum  arabic,  Siss. 
Camphor  water,  Siiss. 

Mix.  This  should  be  used  every  two  hours  as  a 
gargle. 

Or, 

I$5.    Ext.  of  rhatany,  3ss. 
Tinct.  myrrh,  5i. 
Sage  water,  Siss. 
Mix.    This  may  be  used  frequently  as  a  mouth  wash. 

If  there  should  be  fever  attending,  you  can  admi- 
nister 

ty.    Carbonate  of  potassa,  gi. 
Elder  flower  water,  Svi. 
Syrup  of  marsh  mallow,  Si. 
Mix.    A  spoonful  may  be  given  every  hour. 

A  very  pleasant  preparation  is  to  make  lozenges  of 
borax. 


CANKER. 


355 


fy.  Borax,  5ii- 
Sugar,  Sss. 
Mucilage,  q.  s. 

Mix,  and  make  into  thirty  lozenges ;  one  of  which 
may  be  taken  occasionally. 

CANCRUM  ORIS. — CANKER. 

This  disease  frequently  becomes  very  alarming,  from 
the  fact  that  it  has  a  gangrenous  tendency.  The  com- 
plaint is  essentially  ulcerative,  appearing  in  this  form 
at  the  commencement.  It  is  considered  by  some  as  a 
synonyme  of  gangrene  of  the  mouth. 

The  complaint  usually  makes  its  appearance  in  the 
gums,  or  inside  of  the  cheeks  or  lips ;  though  it  may 
occur  in  any  part  of  the  mouth,  or  in  the  fauces.  When 
first  noticed,  it  is  always  in  the  form  of  an  ulcer,  often 
of  considerable  size,  with  a  yellowish-white  or  grayish 
surface,  and  an  inflamed  border.  The  swelling  in  the 
mouth  is  sometimes  so  considerable,  as  to  render  an 
examination  of  the  sore  difficult.  There  is  a  very 
copious  flow  of  saliva,  and  the  breath  is  very  offensive, 
though  the  fcetor  is  distinct  from  that  of  gangrene.  The 
ulcer  is  generally  painful,  and  is  usually  attended  with 
fever  and  constipation.  I  have  never  known  it  to 
penetrate  through  the  cheek,  nor  to  end  fatally.  I 
have  always  found  it  to  yield  to  treatment. 

Treatment. — This  disease  is  almost  universally  accom- 
panied with  constipation,  and  your  first  object  will  be 
to  overcome  this ;  to  do  which  give  castor  oil,  or  rhu- 
barb and  magnesia.  In  obstinate  cases,  attended  with 
prostration,  I  generally  use  the  mineral  acids  in  combi- 


356 


QUINSY,  OR  SORE  THROAT. 


nation  with  quinine.  The  diet  should  consist  chiefly 
of  farina,  tapioca,  &c. 

Your  great  dependence  will  be  upon  local  applica- 
tions. A  distinguished  author  asserts,  that  he  has 
found  nothing  so  useful  as  a  solution  of  sulphate  of  zinc, 
say  fifteen  grains  to  the  fluid  ounce  of  water,  applied 
three  or  four  times  a  day,  by  touching  the  ulcer  with  a 
camel's  hair  pencil.  I  have  no  doubt  but  this  is  a  valu- 
able remedy ;  and  in  this  disease  I  can,  with  the  same 
confidence,  recommend  the  tincture  of  iodine  and  cate- 
chu, applied  in  the  same  manner. 

CYNANCHE  TONSILLARIS. 

Quinsy. — I  shall  describe  the  disease  under  the  name 
of  tonsillitis,  believing  that  to  be  the  proper  name  for  the 
disease.  It  is  very  common,  and  attended  always  with 
danger.  It  is  true  the  tonsils  are  not  only  inflamed,  but 
the  surrounding  parts  are  most  generally  affected.  It 
prevails  in  this  climate  mostly  in  winter ;  I  have  seen 
some  few  cases  in  the  spring.  The  inflammation  some- 
times involves  only  one  gland,  but  most  frequently  both. 
It  is  very  acute,  and  easily  known  by  the  rapid  swelling 
of  the  tonsils,  great  pain  in  the  glands,  difficult  respira- 
tion and  deglutition,  and  I  have  seen  the  inflammation 
extend  throughout  the  whole  of  the  mucous  membrane, 
to  such  an  extent  as  to  essentially  interrupt  the  speech. 
When  the  inflammation  is  so  extensive  you  will  find  the 
uvula  (or  what  is  vulgarly  termed  the  palate  of  the 
mouth,)  much  elongated  and  considerably  swollen.  It 
is  always  accompanied  with  more  or  less  acceleration  of 
the  pulse,  with  general  symptomatic  fever. 

In  some  few  cases  you  will  find,  in  addition  to  the 


QUINSY,  OR  SORE  THROAT. 


357 


inflammation  and  hardness  of  the  glands,  that  they  are 
attended  with  slight  ulcerations  upon  them. 

This  is  one  of  that  peculiar  class  of  diseases  that 
requires  the  best  medical  talents.  The  treatment  must 
be  active  to  subdue  the  inflammation  and  prevent  suffo- 
cation, which  hi  many  cases  is  liable  to  occur  before 
abscess  and  suppuration  will  take  place,  which  afford 
immediate  relief. 

It  may,  and  does  sometimes,  terminate  in  resolution, 
but  most  frequently  in  suppuration,  in  which  event  the 
discharge  is  peculiarly  offensive. 

The  exciting  causes  of  the  disease  are  essentially  cold 
and  wet ;  whether  applied  to  the  body  at  large,  or  to 
the  feet  only.  Cold  applied  in  any  way  is  sugicient  to 
produce  the  disease.  Some  persons,  however,  are  pecu- 
liarly subject  to  inflammation  of  the  throat,  easily  to 
take  cold  from  vicissitudes  of  temperature,  and  in  such 
persons  the  throat  is  particularly  liable. 

Treatment. — You  should  endeavor  to  produce  relaxa- 
tion and  a  free  determination  to  the  surface,  by  inducing 
perspiration  as  speedily  as  possible.  For  this  purpose  I 
use  a  warm  foot  and  hand  bath,  bathing  the  arms  up  to 
the  elbows.  It  is  a  remedy  not  much  used,  but  it  is  one 
of  great. utility ;  it  will  induce  perspiration  and  restore 
the  circulation  to  the  surface  more  readily  than  the 
pediluvium  alone.  You  can  assist  the  action  of  this  by 
bathing  the  whole  body  in  the  alkaline  wash,  with  the 
addition  of  good  brandy.  To  assist  these  local  remedies 
to  produce  relaxation  and  perspiration  I  generally  give 
the  following: 

1^5.    Sanguinaria,  (blood  root,) 
Lobelia  seeds, 


358 


QUINSY,  OR  SORE  THROAT. 


Ictodes  foetida3,  (skunk  cabbage,)  aa.  Siss. 
Good  vinegar,  1  qt. 

Before  adding  the  vinegar,  make  the  powder  moist 
with  alcohol,  let  it  stand  a  few  hours,  then  add  the  vine- 
gar. 

This  should  be  given  in  half  drachm  doses,  in  a  little 
sage  tea,  and  repeated  at  intervals  of  twenty  minutes  or 
more.  Do  not  carry  it  to  the  extent  of  vomiting,  but 
merely  to  keep  up  its  nauseating  effect;  or  if  you  prefer, 
you  can  use  Beach's  Sudorific  Mixture. 

You  will  afford  the  patient  much  relief  by  the  appli- 
cation of 

IJj.    Linseed  oil,  gi. 
Oil  of  capsicum,  3i. 
Spts.  camphor,  Sii. 
Oil  of  turpentine,  5iii. 
This  should  be  freely  applied  to  the  neck,  and  flannel 
wrung  out  of  a  strong  solution  of  hot  vinegar  and  salt 
applied  immediately  after. 

Gargles  are  of  much  service  in  allaying  the  extreme 
irritability  of  the  glands ;  the  sudorific  tincture  that  I 
have  already  recommended,  is  a  valuable  gargle.  I  fre- 
quently use  a  strong  infusion  of  golden  seal  and  borax. 
Some  of  the  following  are  also  highly  extolled : 

^.  Alum, 

Nitrate  of  potassa,  aa.  gi. 

Cream  of  tartar,             t  si. 

Acetic  acid,    -  lb.  i.. 

Dissolve,  and  evaporate  to  dryness.  Half  an  ounce 

dissolved  in  eight  of  water,  is  highly  spoken  of  in  in- 
flammation of  the  tonsils.    Also,  the 


QUINSEY,  OR  SORE  THROAT. 


359 


1^.    Tincture  of  iodine, 

  of  opium, 

Water, 


aa.  51. 
Svi. 


Mix,  and  use  as  a  gargle.  This  should  not  be  used, 
however,  unless  the  glands  are  ulcerated. 

Your  patient  will  frequently  have  relief  afforded  him 
by  the  use  of  the  alcoholic  vapor  bath. 

His  boAvels  should  be  kept  freely  open  with  castor  oil. 

In  protracted  cases,  you  will  derive  great  benefit  from 
scarifying  the  tonsils  freely,  especially  when  the  glands 
are  tense  and  hard.  If  ulceration  supervenes,  you  will 
find  a  strong  solution  of  the  acetate  of  copper  (verdi- 
gris) made  into  a  gargle,  of  great  benefit. 

This  disease  sometimes  becomes  chronic,  when  there 
is  an  enlargement  of  the  glands,  with  more  or  less  indu- 
ration. In  this  form  of  the  disease,  give  iodine  inter- 
nally, and  use  the  same,  in  combination  with  hydriodate 
potash  in  ointment  externally. 

The  walnut  lotion  is  a  most  excellent  remedy,  in  en- 
largement of  the  tonsils.  It  should  be  applied  with  a 
camel's  pair  pencil,  and  it  will  be  found  prompt  in  its 
effects.  The  preparation  is  a  simple  one ;  dissolve  ex- 
tract of  green  walnut  shells,  six  grains,  in  distilled 
water,  fifty  grains. 


Croup. — This  is  a  phlegmasial  affection,  consisting,  in 
our  opinion,  essentially  of  inflammation  of  the  mucous 
membrane  of  the  upper,  or  superior  portion  of  the  re- 
spiratory tube. 

Symptoms. — When  the  affection  is  fairty  developed, 
we  have  a  contracted  and  difficult  respiration,  with  a 


CYNANCHE  TKACHEALIS. 


360 


CROUP. 


peculiar  cough  of  ringing,  barking  kind,  with  very  sono- 
rous respiration  and  hoarse  voice ;  besides  the  cough,  if 
the  disease  be  fully  confirmed,  we  have  a  peculiar  "  hiss- 
ing" respiration ;  but  it  is  mostly  in  the  inspiration  it  is 
heard — there  are,  however,  various  modifications.  The 
voice  is  generally  crowing  or  nearly  suppressed,  and 
there  is  great  difficulty  of  breathing.  There  is  gene- 
rally no  pain  in  the  throat,  nor  is  any  difficulty  expe- 
rienced from  swallowing.  We  have  considerable  expec- 
toration, which  is  of  a  thick  tenacious  substance  from 
the  trachea ;  sometimes  mixed  with  lymph  and  fibrin. 

During  the  first  stage,  we  have  symptoms  of  an  intense 
excitement  of  the  circulation,  hot  skin,  flushed  face, 
pulse  rapid,  and  great  anxiety  of  the  countenance.  The 
general  symptoms  are  very  insidious  in  their  character, 
the  child  being  perfectly  prostrated  at  times,  before  the 
mother  is  apprized  of  the  danger.  These  symptoms 
generally  occur  at  night,  with  increase  of  the  disease  on 
the  next  night ;  when  the  disease  continues,  the  respiratory 
function  becomes  much  impeded,  and  is  almost  entirely 
stopped;  we  have  peculiar  symptoms  that  mark  the 
stage  of  collapse — failure  of  the  vital  powers ;  difficulty 
of  breathing  undiminished;  pulse  weak,  thready  and 
irregular ;  cough  more  suppressed ;  voice  gone ;  face  swol- 
len and  livid;  skin  cold  and  clammy;  and,  if  in  an 
infant,  we  may  have  convulsions.  Patients  have  been 
known  to  recover  at  this  stage,  by  nature  making  an 
effort  at  throwing  off  the  mucous  exudation. 

Varieties. — There  are  the  sthenic  and  asthenic — the 
former  attacks  the  robust  and  plethoric,  whilst  the  latter 
only  preys  upon  the  debilitated.  The  spasmodic  form 
of  croup  frequently  occurs,  and  it  attacks  irritable  chil- 
dren, and  those  whose  temperaments  are  nervous;  as 


CROUP. 


361 


regards  the  nature  of  croup  the  opinions  are  very  various 
and  the  question  quite  unsettled.  Drs.  Elliottson,  Stokes, 
and  Eberle,  agree  that  we  meet  this  disease  under  two 
essentially  different  forms.  They  say,  "it  may  occur 
in  the  first  place  as  a  primary  idiopathic,  and  active 
inflammation  of  the  respiratory  mucous  membrane,  in 
which  case  the  accompanying  fever  is  symptomatic.  In 
the  second  place  we  have  it  preceded  by  fever,  and  the 
formation  of  false  membranes  in  the  pharynx  and  the 
cavity  of  the  mouth ;  which  membranes  by  extending 
downwards  into  the  glottis  and  larynx  produce  the 
symptoms  of  croup,  in  the  advanced  stage  of  another 
and  totally  different  disease. 

Duration  and  Cause. — The  disease  may  last  from 
twenty-four  hours  to  three  or  four  days.  It  is  generally 
the  result  of  an  exposure  to  cold  and  wet,  "  eating  indi- 
gestible articles,"  and,  in  some  instances,  it  appears  to 
be  hereditary. 

Treatment — It  must  be  energetic  and  decided,  your 
great  object  should  be  to  diminish  arterial  action,  to 
prevent  the  formation  of  false  membrane,  and  when 
these  have  been  formed  to  promote  their  expulsion,  and 
to  subdue  spasms,  and  to  support  the  powers  of  life. 
You  answer  the  first  indication  by  a  ready  resort  to  the 
aconite,  by  leeches,  cups  or  blisters  to  the  throat,  and 
by  giving  a  table-spoonful  of  the  following  recipe  every 
fifteen  minutes. 


Until  vomiting  is  excited ;  you  will  also  assist  the  first 


1^.    Infus.  senegae, 


Siv. 

Si 

Shi. 

Si. 


Syrup  ipecac, 
Oxymel  scillaa, 
Tinct.  lobelia, 


3G2 


CROUP. 


indication  by  the  warm  bath  and  an  active  purge.  If 
the  symptoms  still  continue  alarming  I  would  follow 
by  local  depletion,  and  in  extreme  danger  purgatives 
should  be  given  with  the  greatest  freedom.  Some  have 
advised  the  application  of  cold ;  I  have  tried  it  in  some 
few  instances  by  dashing  frequently  cold  water  over 
the  head  and  neck,  and  have  seen  great  benefit  result 
from  towels  soaked  in  water  and  applied  around  the 
neck.  Calomel  was  the  favorite  remedy  of  the  late  Dr; 
Rush.  With  Dr.  Eberle,  rubefacients  and  blisters 
were  important  remedies  in  the  treatment  of  this  disease. 
As  soon  as  hlood  had  been  drawn,  which  I  think  entirely 
useless,  he  applied  some  irritating  liniment  or  a  blister 
to  the  throat  of  the  patient.  In  general,  turpentine 
answers  better  than  any  other  rubefacient  we  possess. 
A  piece  of  flannel  may  be  saturated  with  the  turpentine 
and  applied  around  the  neck.  It  can  be  borne  only 
a  few  minutes  at  a  time,  but  should  be  removed  and 
reapplied  constantly. 

"  When  called  to  a  patient  laboring  under  this  disease, 
the  fauces  should  be  carefully  inspected.  It  is  now  well 
ascertained  that  the  albumenoid  exudation  which  forms 
the  false  membrane  often  commences  on  the  surface  of 
the  inflamed  tonsils,  and  thence  spreads  along  the  arches 
of  the  palate,  and  at  last  descends  into  the  larynx  and 
trachea.  In  such  cases  the  fauces  will  be  found  tume- 
fied and  of  a  dark  red  color,  and  whether  there  be  any 
appearance  of  false  membrane  or  not,  immediate  atten- 
tion should  be  paid  to  this  inflammation.  Dr.  Mackensie 
states  that  the  application  of  a  solution  of  the  nitrate 
of  silver  to  the  tonsils  and  soft  palate,  will,  in  such 
cases,  often  remove  the  membranous  crust  com- 
pletely, and  procure  speedy  and  great  relief,  and  ulti- 


CROUP. 


3G3 


mately  an  entire  removal  of  all  the  dangerous  symptoms. 
The  solution  which  he  employs  is, 

fy.    Nitrate  of  silver,  9i. 
Distilled  water,  %\. 

By  means  of  a  large  camel's  hair  pencil.  This  solution 
is  to  be  freely  applied,  once  or  twice  a  day,  according  to 
the  severity  of  the  symptoms,  to  the  whole  lining  mem- 
brane of  the  fauces.  The  surface  of  the  tonsils,  or 
wherever  else  the  fibrinous  crust  is  actually  in  view, 
will  of  course  be  particularly  attended  to ;  but  I  do  not 
hesitate  to  push  the  pencil  to  the  lower  part  of  the 
pharynx.  This  remedy,  so  far  from  being  productive  of 
any  irritation  beyond  the  mere  mechanical  and  tempo- 
rary one  attending  its  employment,  uniformly  alleviates 
the  symptoms  of  the  croup,  such  as  the  difficult  respi- 
ration, the  barking  cough,  and  the  anxiety  of  the  pa- 
tient. 

In  one  instance  which  came  under  my  notice,  this 
application  was  beneficial.  I  have  been  informed  that 
Dr.  Heard,  of  Washington,  has  used  it  with  great  suc- 
cess. Laennec  has  published  an  account  of  some  cases, 
from  which  it  appears  that  insufflation  of  very  finely 
powdered  alum,  generally  affords  speedy  relief,  not  only 
in  this  variety  of  the  disease,  but  also  in  cynanche 
laryngea  and  tonsillaris ;  four  or  five  grains  finely  pow- 
dered, and  placed  in  the  barrel  of  a  quill,  and  forcibly 
blown  into  the  fauces.  I  have  used  the  syrup  of  garlic 
with  good  effect. 

Liable  to  Recur. — This  disease  occasionally  takes  place 
without  any  inflammation,  or  at  least  very  little.  I 
have  known  children  have  six  or  seven  attacks  of  croup. 

Some  of  the  following  remedies  are  highly  spoken  of, 


304 


MUMPS. 


and  I  can  speak  with  confidence,  that  I  have,  in  some 
few  cases,  derived  signal  benefit  from  their  administra- 


Mix,  and  give  a  tea-spoonful  every  hour,  after  an 
emetic. 

Coxe's  Hive  Syrup  is  much  and  advantageously  em- 
ployed, both  in  regular  and  domestic  practice,  in  all 
stages  of  croup.  Thirty  drops  may  be  given  to  a  child 
two  years  old,  and  repeated  at  short  intervals  till  it 
vomits. 

A  very  distinguished  author,  strongly  recommends 
turpeth  mineral,  which,  while  scarcely  less  efficient  than 
the  antimonial,  he  considers  safer,  as  less  prostrating, 
and  less  disposed  to  act  on  the  bowels.  He  gives  two 
or  three  grains  to  a  child  of  two  years,  and  repeats  the 
dose  every  fifteen  minutes  till  it  operates. 

There  are  cases  which  will  be  relieved  by  the  follow- 
ing cataplasm  of  tobacco,  which,  however,  must  be  used 
with  caution.  Take,  tobacco  §jL,  beat  up  with  water, 
and  form  a  cataplasm,  and  apply  to  the  throat. 


Mmnps. — This  is  an  inflammation  of  the  parotid 
glands,  which  frequently  prevails  in  certain  localities  in 
this  country  as  an  epidemic. 

It  is  preceded  by  heaviness,  lassitude,  and  soon  fol- 
lowed by  stiffness,  pain  and  difficulty  of  motion  about 
the  lower  jaw.    The  parotid  glands,  one  or  both,  be- 


tion  and  application : 

^.    Powdered  valerian, 


5ii. 
Si. 
9i. 
Si. 


Oxymel  of  squill, 

Laudanum, 

Water, 


CYNANCHE  PAKOTIDX 


MUMPS. 


3G5 


come  very  much  swollen,  and  attended  with  an  increase 
of  heat  in  the  part ;  the  inflammation  frequently  involves 
the  sublingual  and  submaxillary  glands ;  when  this  is 
the  case,  the  neck  increases  to  such  an  extent  in  magni- 
tude, as  to  become  alarming. 

It  is  generally  attended  with  fever,  and  some  arterial 
action. 

But  if  from  exposure  to  cold,  or  improper  management, 
the  natural  process  of  the  disease  be  interrupted,  a  sin- 
gular translation  of  the  morbid  action  takes  place.  The 
tumors  about  the  throat  suddenly  subside,  and  are  fol- 
lowed by  swellings  of  the  testicles  in  the  male  sex,  and 
of  the  breasts  in  the  female,  accompanied  with  a  fresh 
exacerbation  of  the  fever.  If  the  swellings  of  these 
parts  be  imprudently  checked,  by  exposure  to  cold,  or  if 
they  suddenly  subside,  the  brain  is  apt  to  become 
affected,  occasioning  convulsions,  delirium,  and  other 
dreadful  symptoms,  which  finally  terminate  in  death. 

It  occurs  generally  but  once  during  life,  and  I  am  of 
the  opinion  that  it  is  contagious.  The  disease  is  usually 
exceedingly  mild,  and  seldom  terminates  fatally,  unless 
under  the  circumstances  just  alluded  to. 

Treatment. — In  a  very  large  majority  of  cases,  very 
little  treatment  is  at  all  requisite.  The  patient  should 
be  confined  to  a  light  diet,  and  avoid  exposure  to  cold 
and  wet  weather ;  to  do  this  effectually,  he  should  be 
directed  to  keep  his  room,  and  drink  freely  of  warm 
ptisans  (teas),  such  as  the  infusion  of  balm  tea,  with  a 
few  drops  of  hartshorn,  sage,  or  catnip. 

If  it  should  be  attended  with  any  constipation  of  the 
bowels,  I  generally  use  a  mustard  pediluvium  (foot 
bath),  and  give  a  small  dose  of  castor  oil  every  three 
hours,  until  it  produces  free  evacuations. 


3GG 


MUMPS. 


If  the  inflammation  should  be  very  considerable, 
accompanied  with  high  fever,  I  give  five  grains  of 
Dover's  powder  in  warm  tea  every  half  hour,  until  free 
perspiration  is  produced. 

Carded  wool  or  cotton  is  good  to  apply  to  the  inflamed 
glands;  and,  when  very  painful,  I  have  used  a  hop 
poultice,  but  more  frequently  advise  Massie's  liniment ; 
or  you  may  bathe  it  with  the  following 

^.    Castile,  soap,  scraped,  5i- 
Sassafras  oil,  Sss. 
Sweet  oil,  Si. 
Camphor,  5iii. 
Mix,  and  apply  it  warm,  placing  carded  cotton  to  the 
surface  immediately  after  its  application. 

In  the  event  that  the  inflammation  should  translate 
itself  to  the  mammae  or  testicles,  the  same  general  treat- 
ment must  be  employed ;  the  testicles  should  be  placed 
in  a  suspensory  bandage,  and  emollient  applications 
kept  constantly  applied. 

In  case  of  metastasis  (from  one  organ  to  another)  to 
the  brain  or  other  vital  organ,  antiphlogistic  measures 
should  be  energetically  employed,  as-  in  inflammation  of 
these  organs  from  other  causes. 

Should  suppuration  take  place,  a  poultice  must  be 
applied,  made  by  adding  Indian  meal  to  beer  until  it  is 
formed  into  the  consistence  of  a  poultice.  The  above 
treatment  has  invariably  been  found  successful. 


INFLAMMATION  OF  THE  KIDNEYS. 


3G7 


DISEASES  OF  THE  KIDNEYS  AND  BLADDER, 

NEPHBITIS. 

This  is  most  frequently  the  result  of  mechanical 
causes,  and  it  is  also  produced  by  pretenders  in  admi- 
nistering, ad  libitum,  turpentine  or  cantharides.  My 
own  impression  is  that  the  inflammation  in  nephritis  is 
generally  in  the  external  membrane  of  the  kidneys. 

Symptoms — There  is  a  pungent  pain  hi  the  loins,  and 
a  very  sharp  pain  in  the  region  of  the  kidneys ;  it  is 
generally,  however,  confined  to  one  side  only.  On  ac- 
count of  the  great  sympathy  existing  between  the  kid- 
neys and  stomach,  there  is  frequently  nausea  and 
vomiting ;  it  is  most  generally  attended  with  some 
degree  of  fever.  There  is  usually  a  frequent  desire  to 
make  water,  which  is  passed  with  difficulty,  and  in 
small  quantities.  The  urine  is  at  first  clear,  and  after- 
wards assumes  a  brick  dust  appearance.  It  sometimes 
involves  the  testicle  of  the  affected  side;  it  becomes 
swelled,  and  very  sore  to  the  touch.  There  is  generally 
a  numbness  experienced  on  the  inner  side  of  the  thigh. 

Pulse. — In  the  commencement  of  the  attack,  the 
pulse  is  full,  hard,  and  frequent,  but  in  a  short  time  it 
becomes,  especially  if  the  attack  is  accompanied  with 
nausea  and  vomiting,  small  and  frequent. 

It  frequently  requires  great  care  in  diagnosis  to  dis- 
tinguish this  from  a  rheumatic  affection  of  the  loins. 
In  the  latter,  the  pain  is  felt  on  both  sides,  and  affects  a 
very  large  surface.  There  is  no  desire  to  make  water, 
no  affection  of  the  testicle,  nor  any  pain  in  the  thigh. 


3G8 


INFLAMMATION  OF  THE  KIDNEYS. 


the  absence  of  these  symptoms  will  most  generally  aid 
you  in  a  correct  diagnosis. 

'Treatment — Your  first  indication  to  fulfil,  is  to  pro- 
duce a  free  determination  to  the  surface  by  inducing 
perspiration.  I  generally  administer  Dover's  powder  in 
five  grain  doses,  repeated  at  short  intervals ;  and  if  the 
attack  is  accompanied  with  much  inflammation,  I  use 
the  uva  ursi  (bayberry)  made  into  a  strong  tea,  or 
administer  the  diuretic  drops,  which  are  composed  of 
the  following. 

^.    Sweet  spirits  of  nitre. 
Oil  of  almonds,  aa.  ^ii. 
Copaibse. 

Oil  of  turpentine,  aa.  Si- 
Mix  these  well  together,  and  add  camphor,  in  pow- 
der, 9i. 

This  may  be  given  in  tea-spoonful  doses,  three  or 
four  times  a  day,  in  the  uva  ursi  tea,  or  mucilage  of  gum 
arabic  or  slippery-elm. 

If  the  pain  is  violent,  I  generally  order  a  hip-bath,  as 
hot  as  it  can  be  borne,  and  as  soon  as  the  patient  is  placed 
in  bed  I  order  fomentations  to  be  applied,  and  for  this  pur- 
pose I  use  worm-wood  and  hops,  steeped  in  hot  vinegar 
and  applied  for  some  length  of  time. 

If  the  attack  is-  violent,  you  will  find  active  purga- 
tion very  essential  in  controlling  the  inflammation ;  the 
bowels  should  at  all  times,  during  the  course  of  the  dis- 
ease, be  kept  in  a  soluble  condition,  and  the  following 
prescription  will  act  most  generally  better  than  oily 
cathartics : 


fy.    Podophyllum,  grs.  x. 

Comp.  powder  of  rhubarb,  5i. 


INFLAMMATION  OF  THE  KIDNEYS. 


3G9 


Mix.  Give  4  grs.  morning  and  night.  (The  com- 
pound powder  of  rhubarb  is  composed  of  the  following, 
viz  : — Bhubarb,  saleratus  and  peppermint,  or  spearmint 
leafbs,  equal  parts.) 

I  have  frequently  seen  cases  where  spasm  arose  from 
irritation  of  gravel  passing  the  ureters,  in  'such  cases  I 
cup  freely  over  the  loins,  order  the  hot  bath,  and  give 
small  portions  of  the  spirits  of  nitre,  spirits  turpentine 
and  morphine  in  combination.  This  will  generally  afford 
relief;  the  dose  should  be  repeated  at  least  every  two 
hours. 

The  patient  must  be  directed  to  drink  constantly  muci- 
laginous diuretics ;  they  must  be  drank  cool,  in  large 
quantities.  Some  recommend  a  decoction  of  marsh  mal- 
lows ;  I  generally  use,  and  with  benefit,  (when  they  can 
be  procured)  green  leaves  of  mullein,  made  with  a  strong 
infusion,  and  let  the  patient  drink  at  least  a  pint  and  a 
half  a  day.  You  will  find,  also,  that  the  bark  or  berries 
of  the  common  sumach,  made  into  a  strong  infusion,  is 
a  most  excellent  remedy. 

Sometimes  the  disease  becomes  chronic ;  in  such  cases 
I  would  advise  Massie's  liniment,  to  be  applied  on  the 
seat  of  the  paim  (the  R.  is  given)  and  if  it  does  not  afford 
relief,  apply  the  strengthening  plaster  heretofore  advised. 
Let  the  patient  drink  of  a  strong  ^nfusion  of  lirioden- 
clron  tulipifera  (tulip  tree)  and  the  monarda  punctata, 
(horsemint.)  This  drink  may  be  alternated  with  the 
mullein ;  where  the  irritability  is  great,  you  will  experi- 
ence benefit  from  a  strong  infusion  of  the  althce  officinalis, 
(marsh  mallows)  which  I  have  heretofore  suggested. 

Vomiting. — If  this  symptom  is  present,  saleratus,  in 
small  quantities,  given  in  mint  tea,  will  generally  allay 
the  irritability  of  the  stomach. 
24 


370 


INFLAMMATION  OF  THE  BLADDER. 


"  If  the  kidneys  suppurate,  you  must  support  the 
strength,  and  tranquilize  the  patient  by  anodynes,  &c. 
The  common  treatment  of  suppuration,  in  any  part  of 
body,  is  that  which  is  required." 

Eegimen. — Every  article  of  a  stimulating  character 
must  be  avoided.  The  diet  must  consist  of  vegetables 
and  mucilaginous  drinks. 

Hydrocyanic  acid  has  been  advised  in  nephritis.  Of 
its  virtues  I  am  not  prepared  to  give  an  opinion. 

The  following,  however,  you  will  find  of  benefit : — 
Groats,  Svi. ;  red  sanders,  chipped,  gi. ;  chicory  root, 
giss. ;  water,  twelve  pints ;  boil  down  one-third,  and  add 
to  the  strained  decoction,  nitre,  (saltpetre)  Bss;  sugar,  gii. ; 
dissolve.  This  should  be  used  tepid,  morning  and  even- 
ing, in  doses  of  from  vi.  to  viii.  5- 

fy.    Carrot  seed,  Bss. 
Boiling  water,  1  pint. 

Infuse.  To  be  taken  during  the  day.  Both  of  the 
above  recipes  are  highly  and  deservedly  extolled. 

CYSTITIS. 

The  various  coats  of  the  bladder  are  subject  to  inflam- 
mation, but  they  resemble  in  disease  each  other  so 
closely,  it  is  not  necessary  to  make  distinctions,  for  in 
reality,  when  one  coat  is  inflamed  it  soon  involves  the 
others. 

The  bladder  is  subject  to  acute  inflammation.  The 
peculiar  symptoms  are  a  throbbing  and  burning  sensa- 
tion in  the  hypogastrium,  (the  lower  part  of  the  abdo- 
men,) with  acute  pain  above  the  pubis,  which  region 
manifests  great  tenderness  upon  pressure ;  a  very  urgent 
desire  to  urinate,  with  an  excruciating  pain  at  the  neck 


INFLAMMATION  OF  THE  BLADDER. 


371 


of  the  bladder  during  the  passage  of  urine,  which  is  gen- 
erally voided  in  drops ;  it  is  accompanied  with  fever, 
which  is  generally  preceded  by  chilly  sensations. 

A  feeling  of  tension  and  fullness  over  the  pubis  is 
often  experienced  from  distention  of  the  bladder,  conse- 
quent upon  retention  of  the  urine.  The  abdomen 
becomes  swollen,  tense,  and  exceedingly  tender,  espe- 
cially when  pressure  is  applied.  Epigastric  uneasiness, 
nausea  and  vomiting  are  not  unfrequent. 

In  the  onset  of  the  disease  the  pulse  is  full  ?nd  hard, 
but  if  relief  is  not  obtained,  it  soon  becomes  irregular, 
small  and  very  frequent. 

It  is  usually  accompanied  with  constipation  of  the 
bowels,  and  I  view  it  as  a  very  formidable  disease. 

Causes. — It  is  frequently  occasioned  by  giving  cantha- 
rides  and  turpentine,  for  gonorrhoea;  sometimes  the 
result  of  stricture,  irritating  injections  and  mechanical 
causes,  as  well  as  by  the  usual  causes  of  inflammation 
in  general. 

Treatment. — It  is  very  similar  to  that  recommended 
for  inflammation  of  the  kidneys.  I  generally  commence 
the  treatment  by  giving  an  active  dose  of  castor  oil,  and 
keeping  the  bowels  in  a  soluble  condition  afterwards  by 
the  administration  of  saline  cathartics.  The  hip  and 
warm  bath  should  be  employed,  together  with  the  local 
application  as  recommended  in  inflammation  of  the  kid- 
neys. 

Some  authors  of  celebrity  speak  in  high  terms  of 
mucilaginous  injections  in  the  way  of  enemas.  My 
impression  is  that  they  do  harm.  I  think  it  is  very 
equivocal  whether  enemas  or  mucilaginous  drinks  should 
be  used.    I  confess  I  have  little  confidence  in  either. 


372  INFLAMMATION  OF  THE  BLADDER. 

The  most  general  indication  is  to  promote  a  free  dia- 
phoresis. After  the  bowels  have  been  freely  evacuated, 
I  generally  administer  Dover's  powders  in  five  grain 
doses,  or  the  spiritus  mindererus,  (acetate  of  ammonia;) 
but  you  will  frequently  find  the  diuretic  drops,  as  pre- 
sented in  inflammation  of  the  kidneys,  a  most  valuable 
remedy.  You  will  find,  in  obstinate  cases,  the  vapor 
bath  will  facilitate  the  action  of  these  remedies. 

When  there  is  excessive  distention  and  much  pain 
upon  pressure,  you  should  immediately  resort  to  the 
catheter,  which,  under  the  circumstances  of  the  disten- 
tion, must  be  introduced  with  great  care.  After  you 
have  relieved  the  bladder  of  its  contents,  by  injecting 
through  the  catheter  a  tepid  infusion  of  hydrastis  cana- 
densis, (golden  seal,) — which  is  a  favorite,  and  deserved- 
ly so,  with  eclectics  generally — say  one  ounce,  it  will 
tend  greatly  to  allay  the  irritation  which  must  necessa- 
rily have  been  produced. 

I  have  administered  Ellis  recipe,  after  the  secretion 
was  drawn  off,  to  allay  pain,  with  decided  advantage, 
viz. : 

ty.    Bicarbonate  of  soda,  5i. 
Almond  mixture,  Biv. 
Copaiba,  5ii- 
Laudanum,  5i. 
Mix.    A  table-spoonful  of  this  to  be  given  occasion- 
ally. 

The  diet  must  consist  exclusively  of  farinaceous  sub- 
stances and  mucilaginous  drinks.  If  there  is  much 
prostration  with  evident  debility,  a  small  portion  of  ale 
or  porter  may  be  allowed. 


CHRONIC  INFLAMMATION  OF  THE  BLADDER.  373 

CHRONIC  CYSTITIS. 

In  acute  cystitis  there  is  often  a  flow  of  mucus  from 
the  bladder,  yet  this  is  a  much  more  striking  phe- 
nomenon in  the  advanced  stages  of  the  disease,  when  it 
may  be  considered  as  having  assumed  the  chronic  form ; 
and,  in  many  cases,  the  grade  of  inflammation  from  the 
commencement  is  such  that  the  affection  may  be  con- 
sidered as  of  that  form  throughout. 

The  symptoms  are  almost  those  of  acute  cystitis,  only 
you  find  them  in  a  modified  form. 

Treatment. — There  is  a  great  variety  of  treatment 
recommended  in  the  chronic  form  of  this  disease ;  my 
experience  in  this  form  is  limited.  Repeated  purga- 
tives are  suggested  by  many;  a  large  number  of  the  pro- 
fession recommend  a  blister  over  the  pubis,  I  am  of  the 
opinion  that  some  harm  might  result  from  this  appli- 
cation, as  strangury  is  easily  induced  when  there  is 
already  irritation  in  the  organs. 

"  Cathartics,  which  especially  irritate  the  rectum, 
should  be  scrupulously  avoided."  The  preparations  of 
castor  oil,  magnesia,  or  sulphur  should  be  used.  "  Most 
generally  remedies"  are  resorted  to  which  have  a  ten- 
dency to  impregnate  the  urine.  "  The  turpentines  or 
their  volatile  oil  are  among  those  most  employed." 
Diosma  or  buchu  has,  within  a  few  years,  been  much 
commended.  "  Other  remedies  of  analogous  character 
are  cubebs,  balsams  of  tolu  and  peru,  tar-water  and 
kreasote."  The  uva  ursi,  (bay  berry)  enjoys  considerable 
reputation. 

Various  teas  are  highly  extolled,  as  those  of  "  bur- 
dock, wild  carrot,  wild  parsley  seed,  dandelion,  and 
pennyroyal." 

M.  Andre  Gilrin,  speaks  in  high  terms  of  fuligo, 


3.74        CHRONIC  INFLAMMATION  OF  THE  BLADDER. 


(soot)  as  an  injection  in  chronic  inflammation  of  the 
bladder ;  he  takes  two  ounces  of  soot  and  boils  it  in  a 
pint  of  water,  niters  it  through  paper,  and  injects  a  small 
portion  two  or  three  times  a  day. 

A  distinguished  author  of  Edinburgh  recommends  the 
following : 

Ty.    Pareira  brava,  5vi.  (a  climbing  shrub,  native  of 

the  West  Indies.) 

Boiling  water,  pint.  i. 

Macerate  for  two  hours,  and  strain,  and  give  from  one 
to  two  fluid  ounces  as  a  dose. 

"  The  tincture  of  the  chloride  of  iron  is  supposed  to 
be  particularly  useful.  The  sulphate  of  quinise,  the 
mineral  acids,"  and  the  preparations  of  iron  generally 
have  also  been  commended. 

M.  Chopart  is  a  great  advocate  for  injections,  and  I 
find  they  are  highly  extolled  by  many  others.  "  In  the 
early  stages  he  recommends  "as  an  injection,  demulcent 
liquids,  such  as  barley  water,  flaxseed  tea,  decoction  of 
marsh  mallow,  &c.  In  the  more  advanced  stages  he 
substitutes  stimulating  substances;  he  begins  with  a 
weak  solution,  gradually  increasing  its  strength,  he 
advises  two  grains  of  the  sulphate  of  zinc  in  the  same 
amount  of  sugar  of  lead,  to  be  dissolved  in  four  ounces 
of  water,  and  to  be  carefully  injected  into  the  bladder 
through  the  catheter  without  using  any  force." 

Various  other  injections  have  been  recommended  by 
Brodie,  Bird,  Bretonneau,  and  others,  such  as  nitric  acid, 
nitrate  of  silver,  corrosive  sublimate,  calomel,  &c.  But, 
in  the  language  of  a  very  distinguished  author,  "  I  should 
fear  even  the  mildest  injections,  lest  more  harm  should 
result  from  their  mechanical  irritation  than  good  from 
any  alterative  or  demulcent  effect. 


SUPPRESSION  OF  URINE. 


375 


The  diet  should  consist  of  boiled  milk  and  farinaceous 
substances,  and  such  other  articles  as  have  no  tendency 
to  occasion  urinary  deposits. 

ISCHURIA  DTSURIA. 

Many  persons  frequently  err  in  regard  to  diseases  of 
the  bladder.  I  have  known  persons  frequently  to  style 
retention,  when  in  truth  it  was  suppression,  and,  vice 
versa.  Dysuria  implies  difficulty  of  passing  the  urine. 
In  this  affection  the  secretion  is  passed  with  great  pain, 
accompanied  with  a  violent  heat  generall}*  of  some  por- 
tion of  the  urethra.  It  is  the  first  degree  of  retention  of 
urine.  Ischuria  renalis  is  most  generally  complicated 
with  this,  and  there  are  many  that  make  no  distinction. 
By  suppression  of  urine,  as  the  title  of  a  distinct  affec- 
tion, is  here  meant,  either  a  complete  cessation  of  the 
secretory  action  of  the  kidneys,  or  a  diminution  of  it  so 
considerable  as  to  be  clearly  morbid.  In  this  affection 
of  suppression  of  urine,  there  is  evidently  a  deficiency  of 
the  secretion  of  urine,  and  generally  accompanied  with 
symptoms  of  nephritis ;  but  we  have  seen  cases  where 
there  was  not  the  slightest  symptom  of  inflammation. 

The  most  prominent  symptom  of  suppression  is  the 
diminution  or  suspension  of  the  passage  of  urine ;  there 
is  no  fullness  of  the  bladder,  and  very  often  upon  exami- 
nation, the  organ  is  found  empty.  It  is  more  frequent 
as  an  attendant  and  result  of  other  diseases. 

I  have  never  had  but  one  case  of  it.  It  is  apt  to  terminate 
in  apoplexy,  and  it  is  certainly  a  very  dangerous  disease. 

Some  few  authors  contend  that  it  sometimes  occurs 
as  an  idiopathic  affection ;  more  frequently,  I  suggest,  as 
an  attendant  on  idiopathic  fevers. 

Treatment. — Your  remedies  should  be  active  and  vigor- 


37G 


SUPPRESSION  OF  URINE. 


oils  diuretics.  You  should  move  the  bowels  by  an  active 
dose  of  senna  and  salts ;  you  should  introduce  the  cathe- 
ter to  ascertain  the  amount  of  secretion  in  the  bladder, 
which  should  be  immediately  followed  by  active  diure- 
tics to  arouse  the  secretion  of  the  kidneys.  To  do  this 
give  the  following.  The  first  is  a  most  excellent  diu- 
retic compound,  viz : 

II  .    Queen  of  meadow  root. 
Dwarf  elder  bark. 
Marsh  mallow  root. 
Mountain  pink,  aa.  Sss. 

These  should  be  bruised  and  placed  in  a  pint  of  boil- 
ing water,  and  the  same  amount  of  gin,  and  steeped  for 
four  hours;  strain  and  sweeten  with  honey.  A  wine 
glassful  may  be  given  every  hour  until  relief  is  procured. 
The  following  is  a  favorite  recipe  of  Prof.  Morrow  : 

1^.  Oil  of  spearmint,  juniper  and  sassafras,  of  aa.  5L ; 
castile  soap,  9iss.  Divide  into  eighteen  pills,  give  three 
pills  three  times  a  day. 

A  very  distinguished  author  recommends  in  this  dis- 
ease, a  grain  of  cantharides  every  eight  hours,  and  the, 
application  of  a  blister  over  the  pubis ;  this  may  be  valua- 
ble if  there  is  no  inflammatory  congestion  of  the  kidneys, 
and  we  know  that  this  substance  has  the  power  of  pro- 
ducing suppression. 

Some  recommend  the  warm  bath  and  Dover's  powders, 
with  the  application  of  a  blister  on  each  side  of  the  spine, 
for  the  purpose  of  keeping  up  a  constant  discharge  from 
the  skin.  I  am  of  the  opinion  that  the  diuretic  drops, 
as  presented  in  inflammation  of  the  bladder,  will  be 
found  a  valuable  remedy  here ;  they  should  be  used  in 
connection  with  mucilaginous  drinks. 


RETENTION  OF  URINE. 


377 


Should  the  urine  be  scanty,  high,  colored  and  loaded 
with  lithic  acid,  no  medicine  will  be  found  more  effica- 
cious than  the  bicarbonate  of  soda,  which  may  be  given 
to  the  amount  of  two  or  three  drachms,  in  twenty-four 
hours,  as  drink,  dissolved  in  a  large  proportion  of  carbonic 
acid  water.  Of  course,  the  diet  should,  in  acute  cases, 
consist  of  vegetable  food  exclusively.  In  cases  of  sup- 
pression, attended  with  symptoms  of  inflammation, 
similar  measures,  with  the  addition  of  cupping  over  the 
kidneys,  are  required. 

M 

RETENTION  OF  URINE. 

In  this  disease  there  is  one  peculiar  symptom,  which 
will  enable  you  to  form  a  correct  diagnosis  between  sup- 
pression and  retention.  In  the  latter  the  pain  is  much 
more  severe  than  in  the  former.  If  it  is  caused  by  any 
mechanical  impediment,  you  must  be  careful  not  to  con- 
found it  with  suppression;  the  latter  always  implies 
inactivity  of  the  kidneys,  and  the  kidneys  are  some- 
times, in  suppression,  so  much  distended  as  to  form  a 
tumor  which  is  discernible  to  the  eye  externally.  Re- 
tention, however,  is  frequently  the  result  of  the  former. 
When  there  is  an  inability  to  make  water,  it  suggests  an 
immediate  examination  of  the  bladder.  In  such  a  case, 
the  distended  bladder,  upon  application  of  the  fingers, 
will  be  found  round,  very  tense,  and  the  tumor  will  rise 
above  the  "pubis ;  in  these  cases  it  must  fce  relieved  of 
the  secretion  speedily,  if  that  be  the  cause,  or  it  will 
finally  burst  into  the  peritoneum,  (the  serous  membrane 
which  lines  the  abdominal  cavity.)  Occasionally,  how- 
ever, you  will  find  in  tympanitic  states  of  the  abdomen, 
that  the  tumor  cannot  be  distinguished  by  the  touch. 


378 


RETENTION  OF  URINE. 


A  complication  of  ascites  (dropsy  of  abdomen)  might 
cause  you  some  embarrassment ;  but  the  peculiar  pain 
produced  by  pressure  on  the  distended  bladder,  or,  if 
this  fail,  the  introduction  of  a  finger  into  the  rectum,  or 
a  catheter  into  the  bladder,  will  soon  decide  the  question. 

Dr.  Wood  says,  there  is  two  conditions  of  retention, 
which  materially  differ  in  their  symptoms ;  one  in  which 
the  affection  is  suddenly  induced,  the  other,  in  which  it 
comes  on  gradually.  In  the  former,  there  is  usually 
much  pain  in  the  hypogastrium  (the  lower  part  of  the 
abdomen)  and  perineum,  (the  space  between  the  anus 
and  genital  organs,)  with  a  constant  and  distressing 
desire  to  pass  water,  but  ineffectual  notwithstanding  the 
strongest  efforts.  The  pain  is  much  increased  by  pres- 
sure over  the  pubis.  If  the  affection  continues,  the 
patient  becomes  feverish,  restless,  anxious  and  exceed- 
ingly distressed,  until  at  length  a  portion  of  the  bladder 
gives  way,  and  the  urine,  he  thinks,  more  frequently 
escapes  into  the  neighboring  cellular  tissue,  than  into 
the  peritoneum,  producing  inflammation,  sloughing,  and 
generally  death. 

When  all  voluntary  power  of  evacuation  seems  to  be 
suspended  or  lost,  it  is  generally  the  result  of  an  over- 
extended bladder,  and  the  very  act  of  distention  has  the 
effect  of  debilitating  the  muscular  coat,  and,  in  the  end, 
if  continued,  of  entirely  destroying  its  contractile  power. 
Hence,  the  habit  of  resisting  the  desire  to  evacuate 
urine,  may,  if*  long  enough  continued,  gradually  induce 
retention. 

Treatment. — When  the  retention,  or,  if  I  may  use  the 
term,  the  mere  stoppage  of  water,  is  entirely  complete, 
it  will  occasion  serious  inconvenience,  and  accompanied 
with  some  danger;  in  such  cases,  you  should  imme- 


RETENTION  OF  URINE. 


379 


diately  resort  to  the  catheter,  which  will  give  speedy 
relief. 

If  the  retention  is  the  result  of  irritation  or  inflam- 
mation, the  treatment  which  we  have  advised  for  the 
cure  of  inflammation  of  the  kidneys,  will  be  the  most 
proper  for  this.  In  general,  you  will  find  the  diuretics 
for  suppression  will  meet  the  emergency  of  this  variety. 
Place  your  patient  in  a  warm  bath,  if  you  have  failed 
to  relieve  him  from  what  has  been  suggested ;  let  him 
remain  for  some  fifteen  minutes ;  let  him  drink  freely  of 
parsley  tea,  with  a  tea-spoonful  of  sweet  spirits  of  nitre 
occasionally.  If  this  should  not  induce  him  to  urinate, 
try  the  following — (where  I  learned  this,  I  have  forgot- 
ten, but  it  has  never  failed  in  my  hands)  : — Take  four 
dozen  bees  from  the  hive,  steep  them  in  half  a  pint  of 
boiling  water  for  some  half  hour,  then  strain  and  let  the 
patient  drink  the  whole  when  cool.  It  looks  extremely 
absurd,  at  the  present  day,  to  venture  to  propose  the 
bee,  (although  it  has  been  done,)  as  a  remedial  agent, 
but  having  fortified  myself  by  experience  with  its  use, 
I  have  no  hesitation  in  recommending  it  to  the  profes- 
sion as  a  therapeutical  agent,  which  will  remove  stran- 
gury and  retention  of  urine,  when  it  results  from 
inflammation,  with  more  promptness  and  certainty  than 
any  remedy  with  which  I  am  acquainted. 

The  spirits  of  mint  is  also  very  efficacious ;  it  usually 
affords  immediate  relief. 

When  the  retention  is  the  result  of  spasm,  an  ano- 
dyne enema  will  be  the  most  effectual  remedy,  in  con- 
nection with  tobacco  or  lobelia  cataplasms  to  the  peri- 
neum, (the  space  between  the  anus  and  genital  organs.) 

Retention  arising  from  deficient  power  in  the  muscu- 
lar coat,  must  be  treated  according  to  the  circumstances 


380 


IXCOXTIXEXCY  OF  URINE. 


in  which  this  loss  of  power  originated.  If  the  spine  is 
the  seat  of  the  disease,  yon  must  cup  and  blister ;  and 
when  there  is  deficient  power  or  paralysis,  I  would  advise 
the  administration  of  ergot,  by  giving  ten  grains  three 
times  a  day.  I  have  frequently  known  the  cold  bath, 
or  cold  douche,  to  give  almost  instantaneous  relief. 

After  the  patient  has  entirely  evacuated  the  bladder, 
he  should  be  extremely  careful  afterwards,  to  imme- 
diately obey  the  call  to  urinate,  for  if  he  should  fail  to 
do  so,  the  least  accumulation  «of  urine  might  reproduce 
the  disease. 

ENEUEESIS. 

This  is  a  more  disagreeable  than  painful  disease, 
although  there  is  a  condition  of  the  urinary  organs 
attended  with  incontinence ;  the  bladder  in  some  cases 
becomes  so  highly  irritated,  that  the  sphincter  muscle 
cannot  resist  the  urgent  desire  to  urinate ;  this  is  gene- 
rally attended  with  some  pain. 

Children  are  more  subject  to  it  than  adults,  although 
I  have  had  many  applications  from  adults,  complaining 
of  having  involuntary  discharges  of  urine,  especially 
when  asleep.  This  form  is  what  constitutes,  in  my 
opinion,  true  incontinence.  It  is  evidently  a  debility 
of  the  urinary  organs ;  the  sphincter  muscle  is  easily 
overcome  from  the  slightest  pressure  of  urine,  or  it  may 
be  quite  destitute  of  the  power  of  contraction.  If  fluids 
or  ardent  spirits  have  a  tendency  to  relax  or  produce 
irritation,  they  should  be  used  in  great  moderation. 

There  is  another  variety  of  incontinence,  which  is 
generally  the  result  of  a  complete  paralysis  of  the 
sphincter  muscle,  and  a  total  loss  of  power  in  the  sur- 


IXCOXTIXEXCY  OF  URINE. 


SSI 


rounding  muscular  fibre.  This  is,  in  most  cases,  the 
result  of  some  mechanical  injury;  it  is  a  deplorable  con- 
dition for  the  patient. 

Though  incontinence  in  itself  is  of  little  importance 
to  the  health,  it  often  becomes  highly  important  in  its 
moral  influences,  affecting  the  character  and  future  life 
of  the  patient. 

Treatment. — Incontinence,  the  result  of  debility,  re- 
quires a  treatment  that  will  restore  tone  to  the  parts ; 
this  will  be  best  effected  bj  the  administration  of  tonics 
and  astringents.  Take  cherry  tree  bark  and  bayberry 
bark  equal  portions,  bruise,  and  add  a  sufficiency  of 
water  to  make  a  strong  decoction ;  let  the  patient  drink 
freely  of  this,  and  administer  a  small  portion  of  the  diu- 
retic drops,  as  advised  in  nephritis.  You  will  sometimes 
find  the  mineral  acids  and  cold  bath  valuable  remedies 
in  this  form  of  the  disease.  Should  those  fail  to  relieve 
this  variety,  you  can  resort  to  the  uva  ursi  in  combina- 
tion with  cantharides.  I  have  great  confidence  in  this 
latter  remedy.  I  have  administered  the  nitrate  of 
potash  (saltpetre)  in  ten  grain  doses,  every  three  hours, 
with  decided  advantage. 

Dr.  Carter  speaks  favorably,  for  the  cure  of  the  above 
variety,  of  the  tincture  of  iodine,  and  the  following  recipe 
has  some  celebrity,  viz. : — 

Powdered  iodide  of  sulphur,  grs.  x. 
Powdered  gum  arabic,  q.  s. 
Mix,  and  divide  into  six  powders — one,  morning  and 
night,  for  an  adult. 

Incontinence,  which  is  the  result  of  an  irritated  state 
of  the  bladder,  or  a  vitiated  condition  of  the  urine,  will 
require  those  remedies  which  are  best  calculated  to  allay 


382 


IMMODERATE  FLOW  OF  URIXE. 


the  irritability.  To  fulfil  this  indication,  I  generally 
resort  to  an  anodyne  enema,  and  those  remedies  which 
I  have  advised  for  cystitis,  (inflammation  of  the 
bladder.) 

Incontinence,  the  result  of  paralysis  and  a  loss  of  mus- 
cular power,  will  require  an  active  and  vigorous  treat- 
ment. You  should  cup  and  blister  on  each  side  of  the 
spine,  and  administer  small  doses  of  the  extract  of  nux 
vomica,  say  half  grain  two  or  three  times  a  day.  I 
woujd  also  advise  the  administration  of  ergot,  as  advised 
for  retention  of  urine. 

The  stimulating  diuretics  may  be  employed  where 
the  affection  is  local.  Electricity,  or  electro-magnetism, 
is  advised  by  many. 

Incontinence  is  sometimes  connected  with  hysteria. 
When  this  peculiar  form  presents,  your  remedies  must 
be  those  that  are  adapted  to  that  affection. 

No  drinks  should  be  allowed  in  the  latter  part  of 
the  day,  and  tea  and  coffee  should  be  prohibited  alto- 
gether. 

DIABETIS. 

This  term  is  most  usually  employed  to  signify  a  super- 
abundant secretion  of  urine,  which  may  be  either  natural 
or  it  may  contain  a  large  quantity  of  saccharine  matter ; 
„  whenever  there  is  a  chronic  excess  of  urine,  with  or 
without  sugar  in  it,  it  is  styled  diabetis  insipidus,  in  con- 
tradistinction to  diabetis  mellitus,  or  true  diabetis,  where 
there  is  abundant  saccharine  matter  in  the  secretion. 

Diabetis  Insipidus. — You  will  frequently  find  an  ex- 
traordinary quantity  of  urine  secreted,  that  has  no  trace 
of  sugar  in  it;  this  variety  is  more  common  in  women 
than  in  men.    In  the  incipient  form,  the  urine  is  very 


IMMODERATE  FLOW  OF  URINE. 


383 


pale  and  transparent,  and  as  the  disease  progresses,  it 
becomes  less  pale,  and  sometimes  has  a  brownish  cast, 
which  is  soon  followed  by  excessive  thirst  and  extreme 
dryness  of  the  skin. 

In  this  form  of  the  disease,  there  is  frequently  passed 
from  half  a  gallon  to  a  gallon  during  the  day,  of  urine. 

Dr.  Prout,  (author  of  a  treatise  on  urinary  diseases,) 
sa}rs,  the  causes  of  this  variety  are  unknown ;  but  men- 
tions as  the  most  probable  predisposing  cause,  hereditary 
influence,  intemperance,  and  the  abuse  of  the  sexual  pro- 
pensity in  early  life,  mental  anxiety,  and  mercurial 
action.  It  is  decidedly  more  apt  to  attack  those  of  spare 
habit  and  nervous  temperament,  and  generally  occurs 
in  those  of  middle  age. 

Treatment. — This  condition  is  very  easily  controlled, 
and  may  very  frequently  be  recovered  from,  by  simply 
wearing  warm  clothing.  The  warm  bath,  and  the  admin- 
istration of  iron,  I  have  known  to .  cure  this  variety. 
Your  treatment  should  be  regulated  upon  general  prin- 
ciples; you  should  assist  the  action  of  the  digestive 
organs ;  you  should  administer  tonics,  to  give  tone  to  the 
general  system ;  regulate  the  bowels  by  enemas  or  gentle 
laxatives,  and  be  active  with  your  remedies,  that  will 
keep  good  action  upon  the  skin.  For  this  purpose, 
Dover's  powders  will  generally  answer. 

Persons  who  have  labored  under  this  form  of  the 
disease  have,  by  medical  men  who  have  not  properly 
examined  the  urine,  been  said  to  be  cured  "of  diabetis, 
as  though  they  had  had  the  saccharine  form  of  the 
disease. 

Diabetis  mellitus  is  characterized  by  an  excessive  dis- 
charge of  saccharine  urine ;  it  generally  exceeds  in  quan- 
tity, during  the  day,  all  the  liquid  which  the  patient 


384  IMMODERATE  FLOW  OF  URINE. 

may  have  taken  during  the  same  length  of  time.  The 
secretion  of  urine  is  generally  pale,  but  as  the  disease 
progresses,  it  becomes  of  a  pale  yellow,  or  greenish  yel- 
low color,  with  a  sweet  taste,  and  rather  agreeable 
smell;  all  of  the  symptoms  appertaining  to  diabetis 
insipidus  will  be  found  here,  such  as  increased  quantities 
of  urine,  thirst,  dry  skin,  and  excessive  hunger ;  clammy 
state  of  the  mouth  and  fauces,  constipated  bowels,  with 
a  daily  increasing  emaciation.  The  feet  and  hands  are 
generally  cold,  and  the  large  mass  of  authors  contend 
that  there  is  one  very  remarkable  symptom,  and  I  have 
observed  it  myself,  which  is,  "  the  complete  loss  of  sexual 
power  and  desire."  I  venture  to  assert  that  this  symp- 
tom will  never  be  found  absent,  and  it  has  frequently 
been  the  first  symptom  noticed  by  the  patient  himself. 
You  will  most  generally  find  costiveness,  emaciation, 
depressed  spirits,  and  swollen  extremities.  In  the  latter 
stages,  you  have  hectic  fever  accompanying  it,  with 
rather  a  full,  quick  pulse,  and  as  the  disease  progresses, 
it  becomes  excessively  weak. 

The  urine  in  diabetis  is  sometimes  albuminpus,  which 
some  authors  assert  is  a  favorable  sign.  Dr.  Prout 
mentions,  that  the  worst  form  of  diabetis  is  where  the 
urine  is  albuminous. 

When  there  is  an  immoderate  flow  of  urine,  and  you 
have  doubt  in  regard  to  your  diagnosis,  the  two  follow- 
ing tests  will  generally  decide  the  difficulty.  Diabetic 
urine  contains  sugar,  which,  like  other  liquids  contain- 
ing a  saccharine  principle,  is  capable  of  undergoing 
vinous  fermentation  upon  the  addition  of  yeast,  and  at  a 
suitable  temperature.  No  such  change  takes  place  in 
healthy  urine,  under  the  same  circumstances.  To 
accomplish  this  test  successfully,  you  add  yeast,  and 


IMMODERATE  FLOW  OF  URINE. 


385 


expose  the  mixture  to  a  temperature  of  70  or  80°.  If 
it  be  diabetic,  an  effervescence  will  speedily  commence, 
gas  will  escape,  and  the  liquor  will  acquire  a  vinous 
odor. 

Another  test.  If  diabetic  urine  be  allowed  to  stand 
without  addition,  in  a  moderate  temperature,  it  will 
undergo  spontaneous  decomposition,  becoming  acid,  and 
having  the  smell  of  sour  milk.  At  this  period  another 
test  will  be,  that  if  it  is  thrown  into  the  fire  it  will  bum 
like  spirits. 

The  specific  gravity  of  the  urine  is  one  of  the  best 
tests.  Healthy  urine  is  generally  from  1.010.  to  1.015. ; 
diabetic  urine  reaches  as  high  as  1.050.,  and  many 
authors  say  they  have  seen  it  much  higher. 

Terminations  of  Diabetis. — That  of  consumption  is 
decidedly  the  most  frequent ;  it,  however,  frequently 
terminates  in  dropsy,  apoplexy,  diseases  of  the  liver,  &c. 
The  general  prognosis  in  regard  to  this  disease  is  deci- 
dedly very  unfavorable  in  its  mildest  form, 

The  [most  important  feature  for  the  practitioner,  I 
conceive,  is  the  pathology  of  the  disease,  (as  for  the 
causes,  they  are  occult  and  obscure,  unless  it  be  to  admit 
that  it  is  sometimes  the  result  of  hereditary  tendencies. 
Some  of  our  ablest  and  most  scientific  physicians  declare 
the  disease  to  be  situated  and  confined  alone  to  the  kid- 
neys ;  while  there  is  another  class,  whose  opinions  are 
entitled  to  great  consideration,  locate  this  disease,  and 
almost  exclusively  confine  it  to  the  stomach.  I  am 
more  than  inclined  to  the  latter  opinion.  Quite  a  vari- 
ety of  the  symptoms  can  be  explained  upon  both  sides 
of  these  conflicting  opinions.  In  support  of  the  latter 
opinion,  the  disease  is  almost  always  accompanied  with 
dyspepsia,  also  costiveness,  emaciation,  hunger,  and  great 
25 


f 


386  IMMODERATE  FLOW  OF  URINE. 

debility,  a  peculiar  sensation  of  prostration  in  the  region 
of  the  stomach.  Some  attribute  these  symptoms  as 
more  applicable  to  the  kidneys,  and  argue  that  the 
absence  of  sugar  in  the  blood,  and  the  frequent  absence 
of  dyspepsia,  or  anything  connected  with  the  stomach, 
except  the  hunger,  (which  the  excessive  loss  will  ex- 
plain,) make  it  appear  most  probable  that  the  disease  is 
situated  in  the  kidneys.  On  page  36  of  Prout's  wo.rk  on 
the  stomach  and  renal  diseases,  that  distinguished  author 
holds  the  following  :  "  In  diabetis,  the  reducing  functions 
of  the  stomach  are  for  the  most  part,  morbidly  active, 
while  the  converting  function  is  more  or  less  suspended 
or  paralyzed.  In  the  diabetic  stomach,  therefore,  sugar 
is  found  in  large  quantity,  particularly  when  vegetable 
aliments  have  been  taken;  and  from  the  stomach  the 
sugar  readily  passes  into  the  sanguiferous  system,  as  just 
stated."  He  further  remarks,  that  within  the  last  twen- 
ty-five years,  that  he  had  seen  upwards  of  £00  cases  of 
diabetis ;  and  of  this  great  number,  as  far  as  minor  and 
concomitant  symptoms  have  been  concerned,  no  two 
cases  had  been  exactly  alike,  or  had  been  benefited  by 
exactly  the  same  treatment.  How  great,  then,  must  be 
the  diversity  of  the  disease. 

Under  the  head  of  diabetis,  the  same  author  makes 
allusion  to  the  article  of  tobacco;  and  his  reasoning  is 
so  much  in  accordance  with  our  views  of  that  pernicious 
drug,  that  we  beg  indulgence  for  inserting  it  here.  We 
are  all  aware  that  tobacco  is  an  article  very  much  used, 
and  the  deleterious  effects  resulting  from  its  use  on  the 
assimilating  organs,  entitles  it  to  great  consideration. 
Dr.  Prout  says  that  "it  is  confessedly  one  of  the  most 
virulent  poisons  in  nature ;  yet  such  is  the  facinating 
influence  of  this  noxious  weed,  that  mankind  resort  to 


IMMODERATE  FLOW  OF  URINE. 


387 


it  in  every  mode  they  can  devise,  to  insure  its  stupifying 
and  pernicious  agency.  Tobacco  disorders  the  assimila- 
ting functions  in  general,  but  particularly,  as  I  believe, 
the  assimilation  of  the  saccharine  principle.  I  have 
never,  indeed,  been  able  to  trace  the  developement  of 
oxalic  acid  to  the  use  of  tobacco ;  but  that  some  analo- 
gous and  equally  poisonous  principle,  (probably  of  an 
acid  nature,)  is  generated  in  certain  individuals  by  its 
abuse,  is  evident  from  their  cachectic  looks;  and  from 
the  dark  and  often  greenish  yellow  tint  of  their  blood. 
The  severe  and  peculiar  dyspeptic  symptoms  sometimes 
produced  by  inveterate  snuff  taking  are  well  known ; 
and  I  have  known,  more  than  once,  such  cases  terminate 
fatally  with  malignant  disease  of  the  stomach  and  liver. 

Great  smokers,  also,  especially  those  who  employ 
short  pipes  and  cigars,  are  said  to  be  liable  to  cancerous 
affections  of  the  lips.  (I  have  known  some  persons  in 
this  city  become  so  nervous  from  smoking,  that  it  almost 
disqualified  them  for  business.  A  very  particular  friend 
of  mine  had  become  so  nervous  from  the  effects  of  smo- 
king, that  he  was  almost  unable  to  write.  At  my  earn- 
est request  he  abandoned  the  use  of  tobacco  entirely,  and 
he  frequently  speaks  to  me  of  the  great  benefit  he  has 
derived  from  following  my  advice.)  It  is  true  the  strong 
and  healthy  suffer  comparatively  little,  while  the  weak 
and  predisposed  to  disease  fall  victims  to  its  poisonous 
operation.  Surely,  if  the  dictates  of  reason  were  allowed 
to  prevail,  an  article  so  injurious  to  the  health,  and  so 
offensive  in  all  its  forms  and  modes  of  employment, 
would  speedily  be  banished  from  common  use.  This  is 
merety  a  sketch;  the  practical  nature  of  my  treatise 
will  not  admit  of  my  extending  these  remarks.  'A 
word  to  the  wise  is  sufficient.'" 


388 


IMMODERATE  FLOW  OF  URIXE. 


Treatment. — This  is  one  of  the  most  peculiar  and 
singular  diseases  we  meet  in  the  animal  economy,  and 
the  treatment  is  just  as  various  as  are  the  opinions  of 
different  authors  respecting  its  nature ;  and  as  Dr.  Prout 
remarks,  there  is  no  disease  in  which  so  much  mischief 
has  been  done  on  false  principles  and  by  random  experi- 
ments as  in  this.  I  contend  that  diabetis  is  nothing 
more  nor  less  than  a  peculiar  form  of  dyspepsia,  and  I 
am  sustained  in  this  opinion  from  the  authority  just 
quoted ;  he  says,  "  it  is  dyspepsia  which  principally  con- 
sists in  a  difficulty  of  assimilating  the  saccharine  ali- 
mentary principle ;  and  that,  like  all  other  forms  of  dys- 
p&pda,  it  is  liable  to  be  much  modified  and  aggravated 
by  concomitant  circumstances. 

The  dietetic  treatment  is  that  which  must  be  exclu- 
sively relied  on ;  I  am  under  the  impression,  if  you  can 
confine  the  patient  to  a  strictly  animal  diet,  recovery 
will  be  more  apt  to  follow  it  than  any  other  course  that 
may  be  pursued ;  it  is  quite  difficult  to  get  a  patient  to 
obey  these  directions,  but  I  never  yield  any  thing  more 
than  stale  bread,  and  I  have  treated  some  few  cases 
successfully ;  there  are  some  distinguished  authors  that 
oppose  this  mode  and  admit  a  vegetable  diet,  and  among 
these,  Dr.  Prout,  says,  "  I  do  not,  however,  approve  of 
a  diet  exclusively  animal,  but  consider  a  certain  pro- 
portion of  farinaceous  matters  proper;"  this,  in  my 
opinion,  is  prejudicial;  it  is  now  a  well  established  fact 
that  those  who  have  been  enabled  to  confine  their 
patients  to  a  strictly  animal  diet  have  cured  a  large 
proportion  of  their  cases,  while,  on  the  other  hand,  those 
that  admit  a  vegetable  diet,  admit  that  their  practice 
has  been  very  unsuccessful. 

In  persons  laboring  under  this  disease  you  will  gene- 


IMMODERATE  FLOW  OF  URINE. 


3S9 


rally  experience  much  difficulty  in  controlling  them  in 
regard  to  their  thirst;  the.  regulation  of  their  drink  is 
one  of  the  most  important  features  of  treatment.  "  For 
it  must  be  observed  that  extensive  indulgence  in  liquids 
is  (on  the  one  hand)  injurious  by  impairing  digestion, 
and  on  the  other,  it  has  a  much  worse  effect  upon  the 
urine  than  merely  increasing  its  quantity  by  simple 
dilution;  since  the  density  is  commonly  found  to  be 
maintained,  though  the  quantity  be  greatly  increased." 

The  quantity  of  food  as  well  as  drink  must  be  care- 
fully regulated.  Weak  beef  tea  and  cold  water  are  the 
only  fluids  that  should  be  allowed.  Dr.  Prout  recom- 
mends distilled  water  very  highly,  and  goes  so  far  as  to 
admit  the  patient  to  drink  porter  in  small  quantities. 

The  medical  treatment  must  be  conducted  on  general 
principles,  and  must  of  course  be  varied  according  to  the 
degree  and  complication  of  the  affection. 

The  bowels  should  be  kept  in  a  soluble  condition ;  if 
there  is  constipation  give  olive  oil  or  rhubarb ;  under  no 
circumstances  administer  a  saline  cathartic.  If  diarrhoea, 
the  muriate  of  morphine. 

You  should  endeavor  to  produce  a  determination  to 
the  surface,  or  otherwise  keep  up  a  good  action  upon 
the  skin,  this  should  be  done  by  exercise  or  tepid  bath- 
ing. Some  recommend  very  highly  opium  in  this  disease , 
I  have  used'  sulphur  and  camphor  with  advantage  in 
determining  fluids  to  the  surface.  Catechu,  alum  and 
iron,  is  said  to  have  cured  the  disease.  Some  European 
authors  speak  in  favorable  terms  of  kreasote ;  the  Ger- 
man authors  are  emphatic  in  its  praise,  they  say  they 
have  used  it  with  "  striking  success."  The  following  is 
a  prescription  which  I  received  from  an  individual  whilst 


390 


IMMODERATE  FLOW  OF  URINE. 


in  attendance  on  a  case  of  diabetis,  and  which  certainly 
did  much  towards  the  cure,  viz : 

ly.    Tannic  acid,  9ii. 
Pulv.  opii.,     gr.  ss. 
Mix,  and  divide  into  ten  powders,  give  one  morning, 
noon  and  night,  gradually  increasing  the  dose. 

Two  cases  are  reported  in  the  Hotel  Dim  of  Paris, 
where  the  animal  diet  had  failed  to  be  of  any  service, 
but  when  the  iodide  of  iron  was  used  in  the  form  of  pills 
containing  five  grains,  and  four  given  in  the  twenty- 
four  hours,  it  gave  speedy  and  effectual  relief. 

Fouquier  states  that  he  has  administered  urea  suc- 
cessfully in  diabetis,  he  gave  from  thirty  grains  to  5h  in 
a  day  in  a  solution  of  distilled  water. 

Phosphoric  acid,  as  recommended  in  the  London 
Pharmacopasia,  is  said  to  exert  a  most  beneficial  influence 
over  the  disease. 

Dr.  Cruickshank  alludes  to  the  influence  of  the  Jiydro- 
sulphate  of  ammonia  in  diabetis ;  this  preparation  had 
nearly  fallen  into  disuse ;  it  was  formerly  employed  with 
the  idea  of  deoxygenizing  the  system  in  diabetis,  and  of 
diminishing  the  morbid  appetite,  which  Dr.  Cruickshank 
says  it  will  do,  given  in  five  drop  doses  in  a  tumbler  full 
of  water  three  or  four  times  a-day. 

The  two  following  prescriptions  are  highly  extolled 
in  this  malady :  ^.  Powdered  kino,  £>i,  powdered 
camphor,  3ss,  aromatic  powder,  9i,  oxide  of  zinc,  grs.  x, 
mucilage  gum  arabic  sufficient.  Make  into  twenty  pills, 
and  give  two  morning  and  evening.  Or, 

ty.    Precipitated  sulphur,  5ii. 
Fennel  water,  fl.  5ni. 


HERPES  TETTER.  301 

Cinnamon  water,      fl.  5i. 
Syrup  of  opium,       fl.  Sss. 
Mix.    Give  table-spoonful  every  two  hours. 

It  is  of  imperative  consequence  to  success  that  viola- 
tions of  systems  as  to  diet  be  scrupulously  avoided. 


DISEASES  OF  THE  SKIN, 

HERPES. 

Herpes. — This  name  formerly  was  applied  to  quite  a 
variety  of  cutaneous  eruptions.  It  is  a  vesicular  dis- 
ease, occurring  in  circumscribed  patches,  characterized 
by  a  great  degree  of  inflammation  at  the  base  of  the 
vesicles.  In  severe  cases  it  is  generally  preceded  by 
more  or  less  fever,  and  it  may  be  distinguished  from 
other  vesicular  diseases  by  the  inflammation,  which  is 
generally  great,  with  which  it  is  attended ;  it  is  usually 
accompanied  with  severe  itching  and  a  burning  pain. 
The  secretion  which  appears  in  the  vesicle  at  first,  is 
perfectly  limpid ;  it  soon  becomes  of  a  milky  cast,  and 
at  length  concretes  into  scabs. 

That  form  of  herpes  zoster,  or  what  is  generally  called 
shingles,  and  the  variety  of  herpes  prceputialis  is  very 
common,  and  frequently  creates  a  great  deal  of  excite- 
ment in  the  mind  of  the  patient. 

Herpes  Zoster,  (or  shingles.) — In  this  variety,  the  clus- 
ters are  generally  situated  upon  one  side  of  the  body. 
Before  the  vesicle  makes  its  appearance,  it  is  preceded 
by  violent  pricking,  tingling  and  smarting  sensations. 
The  vesicles  appear  in  clusters,  and  frequently  extend 


392 


TETTER. 


half  round  the  body;  they  sometimes  make  their 
appearance  on  the  arm,  thigh  or  neck;  this  eruption 
is  generally  confined  to  the  right  side,  which  is  a  very 
great  peculiarity  of  the  disease. 

Herpes  Phlyctanodes,  (a  cutaneous  eruption,  with  no 
fixed  position.) — In  this  variety,  the  eruption  is  very 
irregular,  and  seems  to  be  mostly  confined  to  the  arms, 
neck  and  breast ;  the  vesicles  in  phlyctanodes  are  not  so 
large  as  in  shingles. 

Herpes  Prcepatialis. — This  is  a  variety  that  is  very 
common,  and  young  men  are  frequently  much  alarmed, 
believing  it  to  be  venereal.  This  is  distinguished  merely 
by  its  locality ;  the  eruption  is  situated  upon  the  pre- 
puce, either  upon  the  outer  or  inner  surface.  They  also 
appear  upon  the  pudenda  of  women ;  the  clusters  gene- 
rally are  very  small,  consisting  of  some  five  or  six  vesi- 
cles, which  run  their  course  and  get  well  generally  in 
from  six  to  ten  days. 

When  the  vesicles  appear  upon  the  inner  surface  of 
the  prepuce,  they  are  very  apt  to  break,  and  the  fluid 
sometimes  excoriates  the  membrane  to  that  extent  as  to 
produce  superficial  ulcers ;  these,  by  the  ignorant,  are 
sometimes  treated  as  syphilitic  in  their  character,  and 
frequently  terminate  in  very  obstinate  ulcers ;  it  is  suf- 
ficient to  distinguish  it  from  syphilis  by  its  vesicular 
origin. 

Herpes  Lai  nails. — This  is  distinguished  merely  by  its 
locality,  occurring,  as  its  name  implies,  about  the  lips. 

Herpes  Ccrcinatus,  (Ringworm.) — The  distinguishing 
character  of  this  disease  is  so  well  understood,  that  it 
really  needs  no  description,  every  child  knows  ringworm. 

There  are  other  varieties,  such  as  herpes  iris,  &c, 
which  I  have  never  seen. 


TETTER. 


393 


Treatment. — The  same  treatment  is  applicable  to 
almost  every  variety  of  the  disease,  and  there  is  no  dan- 
ger to  be  apprehended  from  it.  In  herpes  zoster, 
(shingles)  you  must  make  the  patient  avoid  all  stimula- 
ting food  and  drink.  If  it  should  be  attended  with 
febrile  symptoms,  you  will  open  the  bowels  with  a  saline 
purgative ;  if  there  should  be  pain,  I  frequently  admin- 
ister Dover's  Powders  in  5  gr.  doses  every  hour,  which 
act  as  an  anodyne  and  diaphoretic. 

In  regard  to  the  local  treatment,  avoid  all  greasy  sub- 
stances; if  there  should  be  inflammation  sufficient  to 
l^roduce  disagreeable  sensations,  you  will  apply  slippery- 
elm  poultice,  or  a  weak  solution  of  sugar  of  lead,  and  I 
have  sometimes  used  the  warm  bath.  One  of  the  best 
local  applications  I  have  ever  used,  and  I  can  recom- 
mend it  with  confidence,  is  the  powered  oxide  of  zinc ; 
this  should  be  dusted  over  the  vesicular  eruption,  it 
absorbs  the  fluid,  and  soon  eradicates  the  disease.  Lu- 
nar caustic  and  iodine  are  good  remedies. 

In  herpes  prgeputialis  no  internal  remedy  is  necessary. 
Care  must  be  taken  to  guard  the  parts  from  the  clothing, 
which  would  increase  the  irritation.  This  can  be  done 
effectually  by  spreading  Goulard's  Extract  on  linen,  and 
applying.  As  a  general  rule,  either  of  the  following 
solutions  (weak)  will  speedily  relieve  this  affection : — 
sulphate  of  zinc  (white  vitriol),  sulphate  of  copper 
(green  vitriol),  alum,  or  elixir  of  vitriol;  and  I  have 
used  frequently,  with  perfect  success,  washes  of  the 
solution  of  the  chloride  of  lime  or  soda,  and  have  dusted 
with  calomel  and  opium.  According  to  the  indication, 
I  prefer  to  this  latter  the  muriate  of  mercury  or  tincture 
of  iodine.    It  is  sometimes  necessary  to  apply  emollient 


394 


ITCH. 


applications  without;  when  this  is  necessary,  you  will 
find  slippery  elm  the  best. 

Herpes  labkdis  requires  cooling  and  astringent  lotions. 
Cream  is  a  good  application ;  solution  of  sugar  of  lead 
will  most  readily  relieve  this. 

In  regard  to  the  treatment  for  ringworm,  those  reme- 
dies that  are  recommended  for  prseputialis  are  highly 
extolled  for  the  cure  of  this  variety  of  tetter ;  but  the 
most  effectual  and  certain  mode  of  relieving  or  curing 
ringworm,  is  to  cut  a  blister  plaster  long  and  very  nar- 
row, and  apply  it  just  over  the  inflamed  ring.  By  suf- 
fering it  to  remain  for  three  or  four  hours,  it  will  draw 
a  blister,  which  you  will  dress  with  simple  cerate;  it 
will  effectually  cure  the  ringworm. 

SCABIES. — PSORA. 

Itch  is  described  by  most  authors  as  a  pustular  dis- 
ease, but  with  us  it  is  generally  vesicular.  It  is  a  con- 
tagious eruption,  and  always  attended  with  the  most 
excruciating  itching. 

I  am  not  aware  how  long  this  disease  would  last  if 
suffered  to  run  on ;  it  is  attended  with  no  danger  except 
to  infants. 

There  are  two  varieties  of  itch,  but  it  is  not  the  least 
important  to  draw  the  distinction.  One  of  the  peculi- 
arities of  this  disease  that  is  particularly  noticed,  is  that 
the  affected  parts  itch  much  more  after  night,  and  espe- 
cially if  the  patient  is  in  bed,  than  during  the  day. 

The  eruption  at  first  is  very  minute  and  red,  with  a 
transparent,  viscid  liquid  at  the  summit.  The  vesicles 
are  almost  always  distinct,  and  not  clustered  like  many 
other  cutaneous  eruptions. 


CARBUNCLE. 


395 


Treatment. — It  would  almost  be  superfluous  for  me  to 
say,  that  sulphur  still  stands  the  test  as  the  best  appli- 
cation for  this  disease.  A  great  variety  of  additional 
remedies  have  been  proposed,  but  I  really  think  without 
any  material  benefit  to  the  original.  The  following 
ointment  is  the  most  efficacious.  Take  two  parts  of 
sublimed  sulphur,  one  of  carbonate  of  potash,  and  eight 
of  lard — mix  well ;  half  an  ounce  to  be  applied  morning 
and  night  to  the  affected  parts ;  the  patient  using,  at  the 
same  time,  the  warm  bath  every  day. 

Dr.  Hardy,  who  has  charge  of  the  itch  wards  in  the 
Hospital  Saint  Louis  of  Paris,  affirms  that  he  cures  nis 
patients  in  two  hours.  The  method  described  is  as  fol- 
lows : — 

Patients  are  no  longer  admitted  into  the  house  for  the 
treatment  of  the  itch,  as  two  hours  suffice  to  render 
contagion  impossible,  and  the  recovery  almost  certain. 
The  patient  is  put  into  a  warm  bath,  and  rubbed  for  an 
hour  with  yellow  soap;  he  then  passes  into  a  clean 
bath,  where  he  continues  to  cleanse  his  skin  for  another 
hour.  After  leaving  this  bath,  he  is  taken  to  a  parti- 
cular room  fitted  for  the  purpose ;  and,  with  the  aid  of 
one  of  his  fellow-sufferers,  he  is  rubbed  all  over  for  half 
an  hour,  with  the  ointment  we  have  recommended. 

ANTHRAX. 

Carhunde, — This  is  a  very  prevalent  disease  in  this  cli- 
mate, and  in  the  summer  and  spring  you  will  find  more 
than  one  variety  of  phlegmonous  inflammation.  In  the 
general  form,  you  find  inflammation  of  the  subcutaneous 
cellular  tissue,  or  of  that  which  surrounds  the  superficial 
organs.  Now  malignant  anthrax  differs  from  phlegmo- 
nous inflammation,  only  in  the  degree  of  intensity ;  it  is 


306 


CARBUNCLE. 


true,  they  both  consist  in  a  rapid  inflammation  of  the  skin 
and  cellular  tissue,  the  latter  acquires  in  a  short  time  a 
large  size,  and  from  the  fact  of  its  being  deep  seated  and 
bound  by  the  subjacent  parts,  it  is  apt  to  terminate  in 
gangrene,  (mortification) . 

66  Anthrax  commences  as  a  livid  red  swelling,  exact- 
ing attention  by  its  burning,  smarting  pain,  which  con- 
tinues more  and  more  to  an  unbearable  degree.  Its 
distinction  from  a  common  healthy  boil  becomes  more 
and  more  marked  as  it  progresses ;  and  it  is  only  in  rare 
instances  that  it  does  not  show  its  true  character  from 
t\&  beginning.  As  an  abscess,  it  has  no  particular  source 
or  central  cone,  and,  as  an  ulcer,  it  may  be  said  to  com- 
mence fistulous.  As  soon  as  the  more  ordinary  symp- 
toms of  local  inflammation  have  subsided,  or  without 
their  having  gone  through  their  regular  stages,  vesication 
commences,  and  when  it  bursts,  instead  of  a  truncated 
cone  with  one  opening  or  crater,  as  in  the  boil,  there  is 
a  flat  top"  with  many  openings.  From  these  orifices, 
instead  of  healthy  consistent  pus,  an  acid  fluid  exudes, 
resembling  thin  gruel,  and  excoriating  all  parts  with 
which  it  comes  in  contact.  "The  parts  where  they 
originate  seem  to  be  in  a  state  bordering  on  mortifica- 
tion." Some  contend  that  it  is  of  an  essentially  con- 
tagious nature,  which  is  always  connected  with  a  general 
contagious  disease ;  I  am  not  prepared  to  give  an  opinion 
upon  its  contagious  character. 

It  very  frequently  happens  that  anthrax  is  accompa- 
nied with  severe  constitutional  symptoms,  especially 
when  it  has  arrived  in  its  second  or  third  stage ;  it  is  a 
matter  of  considerable  importance,  if  there  is  much  de- 
bility, to  ascertain  the  cause ;  you  will  frequently  find 
severe  irritation  and  inflammation  of  the  principal  di- 


CARBUNCLE. 


307 


gestive  organs;  if  this  inflammation  of  the  digestive 
organs  prevails,  you  will  rely  to  a  great  extent  upon 
antiphlogistics,  (remedies  that  oppose  inflammation). 

Treatment. — It  consists  in  the  employment  of  those 
remedies  which  are  best  calculated  to  relieve  inflammation 
and  to  disengage  the  subcutaneous  cellular  tissue,  and 
to  remove  the  strangulation  of  the  parts ;  to  fulfil  this 
last  indication,  so  soon  as  I  am  satisfied  as  to  the  char- 
acter of  the  inflammation,  I  make  free  and  deep  incisions 
along  the  whole  course  of  the  inflamed  surface,  this  I 
conceive  to  be  a  very  important  part  of  the  treatment ; 
I  sometimes  use  gentle  pressure  to  relieve  the  parts  of 
the  fluid  contained ;  I  generally  make  the  incision  deep 
enough  to  produce  a  free  discharge  of  blood,  and  which 
gives  the  disorganized  fluids  an  opportunity  of  discharg- 
ing through  the  aperture.  I  make  free  incisions  even  if 
the  disease  has  progressed  to  the  third  stage,  not  with 
the  hope  that  they  will  allay  the  inflammation,  but 
merely  to  promote  the  expulsion  of  the  disorganized 
cellular  tissue ;  immediately  after  the  incisions  I  cover 
the  parts  with  an  emollient  poultice,  poppy  leaves  and 
slippery  elm  is  very  good,  frequently  if  there  is  much 
foctor,  (offensive  smell)  I  substitute  a  poultice  of  charcoal 
and  yeast.  A  poultice  containing  pyroligneous  acid  is 
sometimes  indicated. 

If  the  means  advised  are  properly  followed  it  will 
generally  be  sufficient.  But  when  they  make  their 
appearance  in  numbers  they  assume  a  very  malignant 
character,  and  the  means  which  are  calculated  to  subdue 
this  character  are  free  incisions  in  combination  with 
caustic  potash,  and  you  must  proceed  at  once  to  a  free 
and  full  application  of  it. 

When  the  malignant  pustule  presents  under  the  form 


398 


CARBUNCLES. 


of  a  vescicle,  you  make  a  free  incision  to  evacuate  its 
contents  immediately,  after  this  the  denuded  surface 
should  be  carefully  cleansed,  and  some  recommend  a 
dossil  of  lint,  soaked  in  the  chloride  of  antimony ;  but 
.my  own  mode  is  to  take  adhesive  plaster  and  place  on 
the  inflammed  surface.  I  leave  a  small  space  in  the  cen- 
tre, in  which  I  place  a  piece  of  caustic  potash,  and  cover 
with  a  piece  of  lint,  and  apply  a  bandage,  which,  with 
the  addition  of  this  and  the  adhesive  straps,  will  confine 
the  potash  so  it  cannot  extra visate  itself  over  the  adjoin- 
ing surface.  This  dressing  should  remain  on  for  some 
hours,  say  at  least  four,  and  then  dressed  with  an 
emollient  poultice,  a  linseed  one  will  answer  well.  If 
on  examination  you  should  find  fresh  vesicles,  you  should 
immediately  reapply  the  caustic  as  before  directed. 

The  treatment  of  this  affection  should  be  exclusively 
local,  except  in  the  fourth  stage,  or  towards  the  termina- 
tion of  the  disease,  when  it  is  characterized  by  very  dan- 
gerous constitutional  symptoms. 

A  distinguished  author  advises  to  let  the  caustic  potash 
not  only  thoroughly  saturate  the  surface,  but  pass  through 
the  sinuses  into  the  cavities  within,  until  you  are  satis- 
fied that  no  part  of  the  mass  is  untouched ;  he  says, 
"you  need  not  be  under  any  fear  of  increasing  the 
,  patient's  sufferings ;  on  the  contrary,  after  a  little  smart- 
ing for  a  few  moments,  succeeding  the  first  touches,  he 
becomes  perfectly  easy. 

Caustic  applications  which  have  heretofore  been  highly 
extolled,  are  the  liquid  chloride  of  antimony,  and  the 
nitrate  of  mercury,  dissolved  in  nitric  acid.  During, 
as  well  as  after  the  separation  of  the  slough,  the  parts 
should  be  dressed  as  in  mortification. 

The  same  treatment  is  to  be  relied  upon  when  the 


CARBUNCLES. 


399 


disease  has  advanced  to  the  fourth  stage,  when  you  will 
find  more  or  less  mortification,  accompanied  with  small- 
ness  of  the  pulse,  anxiety,  delirium,  and  the  other  symp- 
toms which  indicate  that  the  affection  has  become  general. 
Under  these  circumstances  it  will  be  essentially  neces- 
sary, in  addition  to  the  local  treatment,  to  exhibit  tonic 
and  stimulating  remedies,  such  as  wine,  bark,  &C. 

Whenever  the  diseased  portions  have  entirety  sloughed 
off,  the  following  salve  will  answer  well,  the  black  salve, 
(Beach,)  which  is  olive  oil,  3  qts.,  add  resin  and  bees- 
wax, each  Shi,  mix  together  with  heat  as  high  as  possi- 
ble; add  gradually,  2i  lb.  of  red  lead,  finely  pulverized ; 
stir  it  briskly  until  it  assumes  a  black  color,  then 
remove  it  from  the  fire  and  stir  until  cold ;  when  about 
blood  warm,  add  pulverized  camphor  and  oil  of  sassa- 
fras, Si. 

The  diet  of  the  patient  should  be  as  nourishing  as 
possible,  and  I  would  advise  the  following  restorative 
bitters,  as  there  is  often  a  great  tendency  to  prostra- 
tion. 

fy.    Prinos  vert.,  (black  alder.) 
Senecio  gracilis,  (life  root.) 
Viburnum  prunefolium,  (black  haw.) 
Platanus  occiden.,  (sycamore  bark,)    aa."  Si. 
Macrotrys  race.,  (black  cohosh,)  gii. 

Pulverize  and  mix.  To  two  ounces,  add  two  pints  of 
boiling  water,  two  pounds  of  sugar,  and  one  pint  of  gin. 
Dose,  table-spoonful  three  times  a  day.  A  wine  cordial, 
which  I  think  far  preferable  to  this,  is  spikenard,  Solo- 
mon seal,  gentian,  black  cherry,  and  peach  root,  of  aa. 
Si. ;  add  boiling  water  two  quarts ;  simmer  slowly  down 


400 


SCALD  HEAD. 


to  one ;  strain,  and  add  two  ounces  loaf  sugar,  and  two 
quarts  of  wine.  Dose,  one  wine-glassful  three  times  a 
day. 

The  alkaline  bath  should  be  used  freely  and  fre- 
quently, alternated  daily  with  a  bath  of  the  strong  decoc- 
tion of  oak  bark. 

TINEA  CAPITIS. 

Scald  head  is,  in  my  opinion,  one  of  the  most  conta- 
gious diseases  of  the  skin.  There  are  two  varieties;  in 
one  of  which  the  eruption  is  not  general,  or,  in  other 
words,  it  is  distinct;  in  the  other,  the  eruption  assumes 
a  circular  form,  having  the  appearance  of  ringworm; 
there  is  no  difference  either  in  the  pustules  or  eruption. 

The  disease  is  almost  exclusively  confined  to  children ; 
the  eruption  is  always  confined  to  the  head ;  but  Dr. 
Wood  says  that  it  occasionally  appears  on  other  parts  of 
the  body ;  this  may  be  so,  but  for  myself,  I  confess  I 
have  never  seen  such  a  case.  There  are  a  variety  of 
cutaneous  diseases  that  are  common  on  the  body,  but 
this  disease  is  certainly  more  particularly  confined  to 
the  head. 

It  makes  its  appearance  in  the  form  of  minute  pustules, 
like  yellow  points,  scarcely  rising  above  the  surface,  and 
appearing  as  if  set  in  the  skin  beneath  the  cuticle. 
There  is  usually  but  a  slight  redness  about  them.  They 
are  scattered  very  irregularly,  without  any  peculiar 
arrangement,  though  sometimes  so  crowded  as  to  cover 
portions  of  the  surface  continuously.  They  are  gene- 
rally seated  at  the  root  of  the  hairs,  one  of  which  usually 
passes  through  each  of  the  pustules.  It  is  attended  with 
considerable  itching. 

The  speck  of  pus  soon  concretes  into  a  small  round 


SCALD  HEAD. 


401 


scab,  without  any  rupture  of  the  pustule ;  and  this  event 
sometimes  takes  place  within  the  first  twenty-four  hours. 
The  scabs  multiply,  and  often  meet  at  their  circumfe- 
rence, so  as  to  form  a  continuous  incrustation  of  greater 
or  less  extent. 

It  is  said  by  a  distinguished  author,  that  where  the 
disease  has  been  long  established,  it  is  thought  to  retard 
the  development  of  the  system,  and  to  have  a  debilita- 
ting effect  upon  the  intellectual  faculties. 

Treatment — Owing  to  the  obstinacy  of  the  disease,  and 
its  peculiar  pertinacity,  which  seldom  fails  to  wear  out  the 
patience,  as  well  as  to  baffle  skill,  it  is  essentially  neces- 
sary to  have  a  goodly  number  of  remedies  to  resort  to, 
as  emergency  may  dictate. 

There  is  generally  more  or  less  inflammation  attend- 
ing this  disease,  and  I  am  of  the  impression  that  the 
treatment  should  be,  to  some  extent,  antiphlogistic,  (reme- 
dies that  oppose  inflammation.)  Others  contend  that 
the  treatment  must  be  entirely  local.  I  generally  give 
my  patients  soda  powders,  night  and  morning.  I  have 
the  hair  immediately  removed  from  the  affected  part, 
and  use  warm  water  and  resin  soap,  as  advised  for  the 
cure  of  itchy  and  the  patient  should  be  directed  to  do 
this  every  morning ;  after  which  I  apply  the  following 
ointment,  and  give  it  a  fair  trial  before  you  abandon  it. 

^.  Unguenti  picis  liquidoe,  (tar  ointment,)  *  gi. 

 Hydrargyri  nitratis,  (citron  ointment,)  £ss. 

Mix  well  and  apply  night  and  morning.  Should  this 
ointment  fail,  I  have  resorted  to  an  application  of  castor 
oil,  and  mixing  as  much  calomel  with  it  as  to  thicken  it 
considerably ;  I  have  never  failed  with  this,  where  due 
attention  was  paid  to  ablutions  of  the  head.  I  have  also 
26 


402 


SCALD  HEAD. 


used  the  kreosote  ointment  with  success.  Some  advise, 
as  a  local  application,  sulphur ;  and  I  am  of  the  opinion 
the  recipe  recommended  for  itch  would  be  of  service ; 
others,  oxide  of  zinc ;  the  mineral  acids  in  the  form  of 
lotion,  in  the  proportion  of  a  drachm  to  a  pint  of  water, 
and  the  solutions  of  sulphuret  of  potash,  chloride  of 
lime,  sulphate  of  iron,  zinc  or  copper,  nitrate  of  silver. 

Dr.  Nigan  recommends  in  the  highest  terms,  the  con- 
centrated acetic  acid,  or  radical  vinegar ;  he  saturates  a 
sponge  and  applies  it  three  or  four  minutes he  says  one 
application  will  affect  a  cure. 

When  the  disease  has  existed  for  any  length  of  time, 
you  will  use  aperient  medicine,  and  where  it  is  of  long 
duration,  your  appropriate  remedies  will  be  the  alkaline 
and  sulphurous  washes  and  acidulous  lotions ;  you  should 
use  them  in  strength  according  to  circumstances.  "  Ten 
or  twelve  grains  of  the  potassa  fusa  in  an  ounce  of  distilled 
water,  or  one  or  two  drachms  of  subcarbonate  of  potash, 
dissolved  in  a  pint  of  tepid  water,  are  the  best  alkaline 
applications."  The  first  should  be  applied  for  a  short 
time,  and  the  latter  kept  constantly  to  the  affected  part. 
We  have  used  a  lotion  compound  of  the  following  with 
good  results : 

ty.    Sulphuretti  potassse,  Sss. 

Saponis  venita?,  (turpentine  soap,)  Si. 

Spiritus  rectificati,  (rectified  spirits,)  Biv. 

Tincture  myrrh,  gss. 

Lime  water,  Oj. 

Mix  and  apply  night  and  morning.  No  application 
should  be  used  until  the  head  be  previously  shaved. 

The  following  remedies  are  appreciated  highly  by 
different  practitioners,  such  as  ointment  of  nitric  acid. 


SCALD  HEAD. 


403 


(See  Dub.  Pharmacopoeia.)  It  is  olive  oil,  one  pound ; 
lard,  four  ounces.  Melt  and  add  nitric  acid,  five  drachms. 
Where  the  disease  is  very  obstinate,  the  following  has 
been  advised  : — Corrosive  sublimate,  two  grains ;  acetate 
of  copper,  six  grains ;  distilled  water,  two  pints.  Dis- 
solve, use  this  as  a  wash.  Dr.  Ellis  recommends  calo- 
mel, Sii- ;  burnt  alum,  white  oxide  of  lead,  each,  Sss. ; 
oil  of  turpentine,  5ii. ;  simple  cerate,  Siss.  Mix  well. 
He  applies  this  every  night,  washes  it  off  in  the  morn- 
ing, and  dusts  the  head  with  starch,  and  washes  and 
reapplys  the  ointment  again  at  night. 

Dr.  Armstrong  advises  an  ointment  composed  of  mer- 
cury, four  parts ;  lead,  half  a  part.  Dissolve  separately 
in  nitric  acid,  sufficiently ;  then  mix  with  oil  of  almond, 
twenty-four  parts;  lard,  forty-eight  parts.  Mix  inti- 
mately, and  apply. 

I  have  myself  used  Banyer's  ointment,  and  think  well 
of  it.  It  is  litharage,  two  ounces ;  burnt  alum,  calomel, 
each,  one  ounce  and  a  half ;  lard,  two  pounds ;  venice 
turpentine,  half  a  pound.    Mix  and  apply. 

I  have  as  much  confidence  in  the  iodide  of  sulphur,  in 
this  disease,  as  almost  any  other  remedy.  It  combines 
with  lard ;  you  must  vary  its  strength  according  to  cir- 
cumstances. It  is  generally  made  into  ointment  in  the 
proportion  of  five  parts  of  the  iodide  of  sulphur  to  ninety 
of  lard. 

Dr.  Litchfield  reports  having  cured  many  cases  of 
tinea  capitis-porrigo,  (scald  head)  by  making  this  prepa- 
tion  into  an  ointment ;  he  used  a  half  drachm  of  the 
powder  to  six  drachms  of  simple  cerate. 

I  was  induced,  not  long  since,  to  try  the  cod  liver  oil 
in  an  obstinate  case,  and  I  was  much  astonished  at  the 
remarkable  power  it  possessed  over  the  disease. 


404 


NETTLE  RASH. 


Mr.  Donevan  has  prepared  a  new  remedy  for  the  cure 
of  cutaneous  diseases,  and  especially  scald  head,  the 
hydrargyri  et  arsenici,  iodidrum,  (mercury,  iodine,  and 
arsenic.)  Dr.  Taylor,  of  New  York,  has  prescribed  it 
and  testifies  that  it  produces  a  more  marked  and  prompt 
effect  than  the  various  remedies  usually  resorted  to. 
When  applied  externally  in  cutaneous  diseases,  it  may 
be  diluted  with  an  equal  portion  of  water,  or  farther, 
should  a  weaker  lotion  be  indicated. 

From  the  contagious  nature  of  this  disease,  the  utmost 
cleanliness  should  be  observed;  tepid  and  sulphurous 
baths  should  be  freely  indulged  in. 

After  washing  the  head  with  soap  and  water  well, 
apply  the  saturated  tincture  of  polk  root  twice  a  day. 
Beef  gall  and  vinegar  are  highly  extolled. 

The  anemone  nemorasa,  (wood  anemony)  when  applied 
to  the  head,  is  said  to  be  a  speedy  cure  for  tinea  capitis, 
{scald  head.) 

UETICARIA. 

Nettle  Rash. — This  is  an  eruptive  cutaneous  disease ; 
it  rises  in  what  is  vulgarly  termed  a  whelt,  which  is  a 
round  oval  elevation  of  the  skin ;  it  is  very  red  in  its 
appearance,  and  attended  with  a  most  intolerable  itching. 
I  have  seen  this  disease  so  inflammatory  in  its  character 
that  the  patient  would  be  swelled  to  an  alarming  extent, 
I  have  seen  cases  where  the  tongue  and  throat  was 
swollen ;  it  is  said  that  the  irritation  extends  itself  to 
the  mucous  membrane  to  that  extent  as  to  produce 
cough.  Some  authors  say  they  have  seen  patients 
unable  to  swallow,  and  nearly  unable  to  breathe. 

A  very  distinguished  English  author,  says  there  are 
many  causes  of  nettle  rash.    It  is  produced  in  some 


HEADACHE. 


405 


persons  by  eating  shell  fish,  herrings,  crab  soup,  or  drink- 
ing malt  liquor,  or  white  wine,  and  it  is  frequently  the 
result  of  taking  balsam  copaibae.  Some  persons  have  so 
peculiar  an  idiosyncracy  of  constitution,  that  extreme 
cold  or  heat,  or  any  of  the  causes  mentioned,  will  pro- 
duce the  disease  readily. 

Treatment. — The  disease  is  evidently  inflammatory, 
and  requires  you?  treatment  to  consist  in  gentle  ape- 
rients, low  diet,  warm  baths,  &c.  I  generally  move  the 
bowels  with  a  half  grain  of  podophyllin,  and  two  to 
four  grains  of  the  compound  powder  of  rhubarb,  as 
heretofore  advised.  In  severe  cases,  some  advise  the 
use  of  the  lancet.  Dr.  Beach  says,  if  you  will  bathe 
the  parts  well  with  good  spirits,  and  a  little  gum  cam- 
phor or  celandine,  (tetterwort,)  and  drink  saffron  tea, 
you  will  soon  cure  the  disease. 

It  sometimes  assumes  a  chronic  form,  which  is  very 
obstinate.  In  this  case  you  must  resort  to  antiphlogistic 
means,  and  in  regard  to  local  applications,  you  will  find 
the  chlorides,  prussic  acid  or  nitric  acid  best  to  alleviate 
the  itching. 


CONVULSIVE  DISEASES. 

CEPHALALGIA. 

Cephalalgia  embraces  every  variety  of  headache,  and 
there  is  such  a  diversity  of  character  in  regard  to  it, 
and  it  is  so  exceedingly  common,  that  it  entitles  it  to 
peculiar  consideration.  I  shall  endeavour  to  point  out 
the  peculiarities  in  regard  to  primary,  symptomatic, 
and  idiopathic  headache,  without  attempting  explana- 


406 


HEADACHE. 


tion  of  the  peculiar  phenomena  of  functional  diseases  of 
the  brain. 

Headache  is  of  various  degrees  of  intensity.  Some- 
times it  is  fixed,  sometimes  changeable  in  its  position ; 
the  pain,  at  times,  seems  confined  to  the  muscles  of  the 
head,  and  apparently  very  superficial,  and  again  we 
have  the  pain  deep  seated,  as  if  the  brain  itself  was  its 
locality.  It  is  sometimes  very  transient  in  its  duration, 
and  again  it  is  protracted  for  days. 

I  have  frequently  seen  it  periodical,  being  either  re- 
mittent or  intermittent.  The  pain  may  be  simple,  or 
may  be  mingled  with  various  other  perverted  sensations, 
such  as -giddiness,  fulness  or  distension,  weight  or  light- 
ness, emptiness,  heat  or  coldness,  hissing,  buzzing,  ring- 
ing or  roaring  in  the  ears.  I  have  seen  it  so  intense 
and  excruciating  as  to  produce  temporary  blindness. 

Symptomatic  headache,  is  the  result  of  a  disease  that 
the  patient  may  be  laboring  under.  Idiopathic  head- 
ache, when  the  cause  cannot  be  ascertained,  or  is  not 
recognized  among  special  diseases.  It  is  obviously 
nothing  more  than  a  symptom,  in  either  case. 

Symptomatic  headache  is  so  very  common,  and  is  so 
frequent  an  attendant  upon  such  a  multiplicity  of  dis- 
eases, that  it  would  be  superfluous  to  enumerate  them ; 
suffice  that  you  have  it  as  an  attendant  symptom  in  all 
forms  of  meningeal  and  cerebral  inflammation.  One  of 
the  most'  common  in  that  class  of  diseases  styled  febrile. 
In  diseases  of  the  stomach,  bowels,  kidneys,  uterus  and 
spinal  affections,  it  is  almost  a  constant  symptom. 

"Idiopathic  headache  is  also  not  uncommon."  In 
common  parlance  it  is  generally  styled  nervous  head- 
ache ;  in  its  mode  of  attack  it  is  exceedingly  irregular, 
and  also  irregular  in  the  character  of  the  pain,  it  some- 


HEADACHE. 


407 


times  makes  its  appearance  very  suddenly,  and  at  other 
times  it  is  very  tardy,  and  so  insiduous  from  the  slight 
pains  accompanying  it  as  hardly  to  be  noticed ;  it  gradu- 
ally increases  for  days,  until  it  arrives  at  that  point 
which  makes  it  almost  insupportable.  "  More  frequently 
than  any  other  variety  of  headache,  this  assumes  the 
regular  periodical  form."  In  most  instances  the  pain  is 
in  the  front  of  the  head,  "over  one  or  both  eyes.  After 
continuing  a  certain  length  of  time,  it  not  unfrequently 
provokes  vomiting,  but  differs  from  sick  headache  in  the 
circumstance  that  the  matter  discharged  from  the  sto- 
mach may  be  quite  destitute  of  acid  bile  or  any  acid 
property patients  in  these  case  are  generally  irritable, 
easily  put  out  of  humor,  and  generally  very  impatient. 

We  have  another  form  of  headache,  where  the  pain 
is  of  another  description,  it  is  termed  hemicrania,  (neu- 
ralgia,) it  is  easily  distinguished  from  the  contraction  it 
generally  produces  in  the  muscles,  and  from  the  fact 
that  the  pain  is  generally  confined  to  some  particular 
nerve,  when  such  is  the  case  it  is  called  "tic  douloureux;" 
it  sometimes  does  not  confine  itself  to  particular  nerves, 
but  confines  itself  to  one  locality.  No  intermission, 
attacks  various  parts  of  the  head,  this  is  very  common 
in  hysterics.  "It  occurs  especially  in  hysterical  pa- 
tients." 

We  have  a  disease,  rheumatism  of  the  scalp,  which 
is  frequently  mistaken  for  cephalalgia,  (ordinary  head- 
ache,) it  is  very  easy  to  make  a  proper  diagnosis  in  re- 
gard to  this  variety ;  where  the  pain  is  evidently  rheu- 
matic it  is  attended  with  a  great  degree  of  coldness,  the 
pain  is  generally  more  acute  in  the  evening,  it  frequently 
extends  to  the  face;  there  is  great  tenderness  of  the  scalp, 


408 


HEADACHE. 


frequently  attended  with  perspiration,  as  in  common 
rheumatism. 

The  last  and  most  important  variety  is  sick  headache, 
the  pain  seems  to  confine  itself  particularly  over  the 
brow,  and  it  is  generally  attended  with  great  nausea 
and  very  frequently  vomiting;  it  is  sometimes  called 
bilious  headache,  and  appropriately  so,  from  the  fact 
that  the  discharges  from  the  stomach  are  most  generally 
very  bilious.  At  the  present  day  a  very  large  majority 
of  medical  authors  attribute  this  disease  to  an  affection 
of  the  stomach,  which  I  am  very  sure  is  just  in  many 
cases  but  not  necessarily  so  in  all.  (The  stomach  as 
well  as  the  liver  are  very  frequently  charged  by  medical 
gentlemen,  when  at  a  loss  for  a  correct  diagnosis,  with 
not  performing  their  functions  properly,  and  this  is 
especially  so  in  regard  to  the  liver ;  my  experience  is, 
that  that  organ,  even  in  this  climate,  is  as  seldom  affected 
as  almost  any  other.) 

I  have  seen  cases  where  the  pain  in  the  head  was 
severe  and  existed  some  time  before  there  was  the  least 
evidence  even  of  nausea;  in  these  cases  I  thought  the 
stomach  affected  sympathetically.  "  We  ought  not 
always  to  infer  that  the  stomach  originally  is  in  fault, 
simply  because  it  is  disturbed  as  well  as  the  head." 
Persons  who  are  predisposed  to  this  variety  of  headache 
I  have  no  doubt  can  bring  them  on  by  overloading  the 
stomach.  "  In  a  great  many  cases  the  stomach  is  not 
affected  until  the  derangement  of  the  head  has  arrived 
at  a  certain  point,  but  the  state  of  the  stomach  will 
bring  it  on,  and  so  also  will  costiveness ;  it  is  precisely 
the  same  with  all  other  affections  of  the  head  and  of 
the  alimentary  canal." 


HEADACHE. 


409 


Treatment. — It  would  be  almost  impossible  to  prescribe 
a  treatment  for  symptomatic  headache.  Whatever  cause 
produces  it,  you  must  direct  your  remedies  to  it ;  when 
you  remove  the  cause  you  will  have  necessarily  removed 
the  symptoms.  Cephalalgia  is  frequently  produced  by 
the  use  of  stimulants,  also  by  coffee  and  tobacco ;  and 
you  will  most  frequently  find,  when  you  can  prevail 
upon  your  patient  to  abstain  from  these  articles,  that  he 
will  seldom  suffer  with  headache.  The  bowels  should 
be  kept  in  a  healthy  state  by  mild  aperients ;  dried  figs 
sometimes  answer  this  purpose  well.  There  is  some- 
times a  very  great  pain,  to  such  an  extent  as  to  require 
immediate  action/ to  relieve  which  bathe  the  feet  in 
warm  water,  and  apply  a  poultice  of  meal,  vinegar  and 
mustard  to  the  extremities.  Opiates  will  sometimes  give 
temporary  relief.  Some  recommend  Hoffman's  Ano- 
dyne, in  drachm  doses,  and  Dr.  Wood  says,  strong  tea 
will  most  generally  give  relief.  Cologne  water  and  bay 
rum,  applied  to  the.  back  of  the  neck,  will  sometimes 
afford  relief.  Ether,  applied  to  the  head,  will  frequently 
produce  ease. 

Nervous  headache  is  generally  the  result  of  irritabilT 
ity  of  the  nervous  system.  And  I  have  frequently 
given  relief  by  the  administration  of  the  tinctures  of 
aconite  and  belladonna,  in  alternated  drop  doses  every 
hour  or  two,  and  continued  through  the  day.  Some 
extol  very  highly  valerian  and  diaphoretics.  Dr.  Beach 
recommends  equal  parts  of  blood  root  and  bayberry, 
pulverized  and  used  as  a  snuff.  I  have  seen  cold  water 
applied  to  the  head  with  decided  advantage. 

In  this  form  of  headache  the  following  prescription  I 
can  confidently  recommend.  It  is  the  favorite  of  some 
eclectic,  whose  name  I  have  forgotten,  and  I  regret  it 


410 


HEADACHE. 


the  more,  as  he  should  have  credit  for  a  remedy  that 
really  possesses  so  much  power  in  controlling  this 
disease. 

•  E.    Pulv.  Scuttellaria  lateriflora,  (scull  cap,) 

 Cypripedium  pubescens,  (lady  slipper,) 

 Nepeta  catarise,  (catnip,)  aa.  3ss. 

Steep  for  twenty  minutes  in  a  quart  of  boiling  water, 
strain  and  sweeten  with  sugar.  Give  a  table-spoonful 
every  five  or  ten  minutes. 

Very  favorable  reports  have  been  made  in  regard  to 
strychnine  in  nervous  headache.  I  have  used  it  advan- 
tageously in  neuralgia,  in  the  21st  part  of  a  grain  three 
times  a  day,  and  think  well  of  it. 

Chloroform,  locally  applied,  is  a  very  valuable  remedy. 

In  some  cases  you  will  afford  speedy  relief  by  apply- 
ing the  following  lotion : 

1^.    Laurel  water,  Siv. 
Sulphuric  ether,  gi. 
Extract  belladonna,  9ii. 

Cover  the  affected  parts  with  folded  cloths,  and  keep 
them  constantly  wet  with  this  lotion. 

In  headache,  •  where  it  is  intermittent  or  remittent, 
the  sulphate  of  quinine,  in  five  grain  doses,  is  your  best 
remedy. 

Sick  Headache, — "This,"  says  a  very  distinguished 
author,  "  is  a  most  intractable  complaint.  I  have  known 
it  affect  many  persons,  in  whom  all  the  remedies  that 
were  employed  failed  in  accomplishing  any  material 
aid.  Now  and  then  the  pain  is  so  intense  that  a  degree 
of  phrenitis  occurs,  (inflammation  of  the  brain,)  and  we 
must  then  treat  it  as  phrenitis."  Your  patient  should 
avoid  anything  that  has  a  tendency  to  disagree  with  his 


NEURALGIA. 


411 


stomach ;  his  bowels  should  be  kept  in  a  soluble  condi- 
tion. Cleanse  the  stomach  by  a  brisk  emetic,  and  give 
sul.  quinine  or  ferrocyanuret  of  iron,  in  combination  with 
belladonna,  very  small  doses,  frequently  repeated. 

NEURALGIA. 

Neuralgia  is  a  term  employed  to  designate  pain  of  a 
purely  nervous  character. 

Symptoms. — The  pain  is  of  every  possible  degree  of 
severity  and  intensity.  It  is  generally  a  stabbing  or 
plunging  pain,  sometimes  peculiarly  lancinating — in 
fact,  you  can  employ  no  expression,  the  terms  of  which 
would  be  too  strong  to  convey  the  amount  or  the  inten- 
sity of  the  pain  suffered  in  this  disease.  Tic  douloureux 
was  the  name  formerly  used  to  express  this  disease. 

Those  that  are  peculiarly  subject  to  this  disease,  are 
generally  of  nervous  temperaments ;  the  least  irritation 
will  sometimes  produce  it ;  the  muscles  commence  quiver- 
ing and  drawing ;  it  may  consist  of  one  continued  pain, 
or  of  a  multiplicity  of  violent  twitches,  varying  in  a 
degree  of  intensity.  Sometimes  between  the  pain  there 
is  a  constant  aching ;  the  parts  become  benumbed,  and 
frequently  the  surrounding  organs  participate  hi  this 
latter  feeling. 

The  pain  is  generally  confined  to  the  course  of  a 
nerve,  but  not  always;  frequently  darts  as  rapid  as 
lightning  from  one  point  to  another,  when  really  there 
is  no  nervous  communication  between  the  two  localities. 

Dr.  Wood  says,  in  accordance  with  the  general  law, 
that  where  there  is  irritation  there  will  be  an  afflux  of 
blood,  the  paroxysm  is  often  attended  with  more  or  less 
flushing  and  vascular  turgescence,  and  occasionally,  if 
the  affected  part  has  the  power  of  secretion,  with  a 


412 


NEURALGIA. 


copious  extravasation  of  liquid ;  as,  for  example,  of  tears, 
when  the  disease  is  seated  in  the  eye,  and  of  mucous, 
when  in  the  nostrils.  I  have  observed  the  superabun- 
dance of  secretion,  but  in  the  cases  I  have  witnessed, 
there  was  no  flushing,  no  swelling,  no  redness,  not  a 
symptom  indicating  any  congestion  or  inflammation. 

It  generally  assumes  a  periodical  type,  and  the  pain 
is  so  intense  as  to  frequently  produce  delirium.  In 
hysterical  females,  portions  of  the  surface,  at  times, 
become  exquisitely  tender. 

Causes* — There  is  a  great  variety  of  opinion  upon 
this  point ;  some  contend  that  it  originates  from  cold,  or 
irritation  of  the  nerve ;  others  contend  that  it  is  a  dis- 
ordered state  of  the  nervous  trunk ;  others  again  admit, 
as  all  do,  that  the  disease  frequently  occurs,  when  it 
cannot  be  explained  at  all,  and  after  death  nothing  has 
been  found.  In  fact,  the  true  nature  of  the  disease  is 
very  often  a  great  mystery. 

Treatment. — There  is  quite  a  diversity  of  opinions  in 
regard  to  the  treatment  of  this  disease,  and  equally  as 
much  diversity  in  the  remedies  .used.  Your  first  object 
should  be,  if  possible,  to  ascertain  the  cause ;  if  this  can 
be  ascertained,  you  must  adopt  your  treatment  accord- 
ingly. If  it  is  obvious  or  presumable,  that  there  is 
inflammation,  or  any  evident  signs  or  symptoms  of  it 
being  rheumatic,  you  will  resort  to  an  antiphlogistic 
treatment  both  general  and  local.  You  may  find  the 
pain  the  result  of  inflammation ;  this  latter  may  sub- 
side and  the  pain  still  remain.  When  the  disease  is 
rheumatic  and  not  inflammatory,  you  will  find  the  fol- 
lowing recipe,  in  connection  with  the  local  application 
of  chloroform,  to  answer  well : 


NEURALGIA. 


413 


1^.    Sulphate  quinine, 
Oil  of  valerian, 
Aromatic  sulphuric  acid, 


3l 

gtts.  XX. 
gtts.  iv. 


Make  into  an  emulsion,  and  give  one-sixth  every  four 
hours,  continuing  it  for  at  least  four  or  five  days. 

Dr.  Wood  says  neuralgia  is  often,  intermitting,  and 
when  not  so  at  first,  often  becomes  so.  The  physician 
should  always  be  on  the  watch  for  this  state  of  the  dis- 
ease,  as,  by  availing  himself  of  the  power  of  anti-peri- 
odical remedies,  he  will  almost  invariably  be  able  to 
arrest  it.  I  do  not  think  you  will  ever  fail  in  curing 
regular  intermitting  neuralgia,  of  the  quotidian  or  ter- 
tian character,  if  you  will  administer  the  sulphate  of 
quinine,  in  five  grain  doses,  every  three  or  four  hours, 
between  the  paroxysms. 

Arsenic  is  another  anti-periodic  remedy,  which  has 
proved  very  effectual  in  this  form  of  neuralgia. 

Neuralgia,  not  periodical  in  its  character,  but  which 
appears  to  be  uncomplicated,  is  not  without  remedy. 
We  generally  give  subcarbonate  of  iron ;  take  a  drachm 
and  divide  it  into  six  closes,  and  give  one  in  syrup  every 
four  or  six  hours.  Whilst  giving  this  preparation,  the 
bowels  should  be  kept  regular,  by  the  administration  of 
one  or  two  pills  a  day,  composed  of  equal  parts  of  rhu- 
barb, aloes,  and  castile  soap. 

You  will  frequently  find  the  hydriodate  of  potash 
given  in  doses,  from  five  to  ten  grains,  some  three  or 
four  times  a  day,  to  act  well,  especially  if  alternated  with 
a  half  grain  of  morphine,  or  strong  hop  tea.  In  connec- 
tion, Dr.  Turnbull  advises  the  local  application  of  aco- 
nite, (monk's  hood.)  Use  it  according  to  the  following 
formula : 


414 


NEURALGIA. 


fy.    Aconite,  (monk's  hood,)        grs.  iv. 

Alchohol,  gtts.  vi.  to  x. 

Lard,  3i. 
Make  into  an  ointment ;  rub  a  small  portion  over  the 
affected  part  until  the  pain  subsides. 

There  are  a  great  variety  of  remedies  recommended 
for  this  disease,  the  administration  of  which,  will  depend 
entirely  upon  the  judgment  of  the  physician,  such  as 
hydro-cyanic  acid,  bebeeria,  electro-magnetism,  (which  I 
have  seen  tried  and  it  gave  immediate  relief)  acetate  of 
morphine,  nux  vomica,  strychnine,  and  chloride  of  lead. 

I  am  of  the  impression  that  local  remedies  afford  as 
much  relief,  and  are  as  much  to'  be  relied  on  generally, 
as  remedies  given  internally.  The  following  have  been 
highly  extolled  as  local  applications  in  the  different 
varieties  of  neuralgia : 

ty.    Resin  plaster,  ^iii. 
Ext.  of  belladonna,   ,  £iss. 
Melt  the  plaster  by  means  of  a  water  bath,  and  add 
the  extract.    Mix  well  and  apply. 

ty.    Soap  liniment,  Bii. 
Chloroform,  3i. 
Mix  well,  and  use  as  an  application  on  the  affected 
organ.    I  have  used  chloroform  alone,  and  in  combina- 
tion with  equal  portions  of  spirits  of  camphor,  and  I 
think  the  latter  decidedly  preferable. 

^.    Ext.  tobacco,  3i. 
Simple  cerate,  gi. 
Mix,  and  use  as  a  friction  over  the  seat  of  pain. 

Much  may  be  done  with  this  variety  of  remedies  to 
afford  relief  to  the  patient.    The  local  remedies,  as  we 


EPILEPTIC  FITS. 


415 


before  observed,  are  more  numerous  than  those  inter- 
nally employed.  A  very  distinguished  physician  asserts, 
that  on  the  whole,  the  most  efficacious  are  the  narco- 
tics, (substances  which  have  the  propert}^  of  stupifying.) 
Laudanum  may  be  applied  by  lotion,  or  in  the  form  of 
a  cataplasm ;  the  liquid  preparation  of  opium  and  canir 
phor  may  sometimes  be  usefully  combined.  The  same 
remarks  are  applicable  to  hydrocyanic  acid  and  cyanuret 
of  potassium.  The  latter  may  be  applied  in  the  propor- 
tion of  one  or  two  grains  to  a  fluid  ounce  of  water ;  or, 
the  following  ointment  is  recommended  for  hemicrania 
and  neuralgia : 

1^.    Pure  chloroform,  5iii. 
Cyanide  of  potassium,  5iiss. 
Lard,  Sii. 
Add  sufficient  of  white  wax  to  make  an  ointment. 

The  endermic  method  of  application  is  sometimes  also 
highly  useful.  A  small  blister  may  be  made  in  the 
vicinity  of  the  pain,  the  cuticle  (skin)  removed,  and 
half  a  grain  of  powdered  acetate  of  morphine  sprinkled 
upon  the  surface. 

This  is  a  very  painful  and  obstinate  disease ;  the  ima- 
gination exerts  a  peculiar  influence.  You  must  tran- 
quilize  your  patient,  and  apply  remedies  to  meet  the 
emergencies  of  the  case. 

EPILEPSIA. 

In  epilepsy  there  is  an  immediate  loss  of  sense,  with 
convulsions  of  the  voluntary  muscles. 

The  patient  most  generally  has  premonitory  symptoms 
similar  to  those  that  usher  in  nervous  affections  in  gene- 
ral ;  occasionally  they  have  no  warning ;  have  the  fit, 


416 


EPILEPTIC  FITS. 


and  afterwards  have  no  knowledge  of  it.  The  warning 
is  generally  sufficient,  the  patient  has  .head-ache,  and 
very  frequently  vertigo  preceding.  I  have  a  patient 
now  that  always  complains  of  an  itching  or  tingling 
sensation  before  the  fit  comes  on. 

Symptoms. — The  patient  is  immediately  deprived  of 
all  consciousness,  the  countenance  pale,  the  lips  are  livid, 
the  mouth  distorted  and  foaming,  the  neck  and  cheeks 
much  swollen,  the  tongue  frequently  much  bitten,  the 
eyes  are  rolled  up  and  appear  to  be  set,  the  urine  and 
fasces  are  sometimes  involuntarily  discharged,  the  respi- 
ration is  very  laborious,  deep  and  irregular.  This  state 
soon  passes,  the  patient  is  left  much  prostrated,  his 
whole  frame  is  bathed  with  perspiration ;  but  frequently 
alarming  symptoms  follow  the  fit ;  in  many  instances 
the  patient  is  so  much  prostrated  that  he  lies  in  a  coma- 
tose condition,  (profound  state  of  sleep,)  temporary  in- 
sanity sometimes  follows  the  paroxysm. 

The  fits  occur  most  frequently  after  night,  generally 
come  on  very  soon  after  the  patient  has  gone  to  sleep, 
they  generally  have  no  knowledge  of  the  fact  unless 
their  feelings  of  lassitude  and  prostration,  which  they 
invariably  experience  afterwards,  imparts  this  informa- 
tion. 

Those  patients  who  are  subject  to  these  attacks  gene- 
rally are  very  dull  in  their  intellectual  faculties,  with 
but  little  energy.  It  has  been  asserted  that  of  any  given 
number  of  epileptics,  two-thirds  at  least  are  in  a  state  of 
idiocy  or  dementive,  (the  mind  becomes  impaired.) 

Frequency  of  Attacks. — The  interval  between  the  par- 
oxysms is  very  variable,  and  there  is  no  certainty  what- 
ever in  regard  to  it ;  the  few  cases  however  I  have  met 
with  here,  have  all  presented  a  regular  periodicity ;  yet 


EPILEPTIC  FITS. 


417 


there? is  no  doubt  but  this  is  liable  to  great  uncertainty; 
and  in  general,  as  we  have  before  remarked,  not  the 
least  calculation  can  be  made  as  to  the  period  of  attack. 

There  is  a  great  variety  in  epilepsy ;  I  have  described 
the  form  we  have  met,  and  we  are  not  as  particular  as 
some,  if  it  is  epilepsy  that  is  enough  to  know,  without 
quarrelling  over  the  fact,  whether  there  is  a  complete 
loss  of  sense,  with  general  convulsions,  or  an  incomplete 
loss  of  sense,  with  partial  convulsions. 

Drs.  Darwin  and  Pritchard  both  affirm,  and  it  is  no 
mean  authority,  that  "  somnambulism  or  walking  in 
sleep"  is  an  epileptic  disease;  others  contend  that  "night- 
mare" is  a  slight  degree  of  epileptic  affection. 

Causes. — We  see  this  disease  very  frequently,  in  fact 
it  is  common  in  infants  and  young  children,  they  are 
certainly  more  subject  to  epilepsy  than  the  adult,  and  I 
have  no  doubt,  the  latter  more  so  than  the  aged.  Some 
authors  contend  that  it  is  more  common  among  females 
than  males,  this  is  not  in  accordance  with  my  experience. 
On  examining  my  note  book,  where  I  have  entered  all 
the  important  cases  I  have  met,  I  find  I  have  seen  thirty- 
seven  cases,  twenty-six  of  which  were  female  children, 
nine  male  children,  and  two  male  adults. 

Some  contend  that  there  is  a  certain  hereditary  dispo- 
sition in  epilepsy,  and  there  is  probably  much  truth  in 
this  opinion.  The  causes  which  predispose  to  epilepsy 
are  certainly  not  well  understood,  and  in  a  large  majority 
of  cases  are  inexplicable. 

If  there  be  a  very  strong  disposition  to  epilepsj?,  then 
even  slight  exciting  causes  may  produce  it,  they  have 
been  "  enumerated  as  follows :  excessive  mental  appli- 
cation or  emotion,  especially  fright,  tickling  of  the  soles 
of  the  feet,  or  the  sides,  masturbation  and  venereal" 
27 


418 


EPILEPTIC  FITS. 


excesses.  (In  one  of  my  adult  cases  this  pernicious  habit 
had  been  constantly  indulged  in.)  "  Great  fatigue,  long 
protracted  watches,  over-suckling,  excessive  pain,  the 
presence  of  worms  in  the  intestinal  canal,  repercussed 
eruptions,  &c." 

Dr.  Hall  considers  all  convulsive  diseases  to  be  affec- 
tions of  the  true  spinal  marrow,  and  ranks  epilepsy  also 
among  centric  convulsions,  which  may  be  induced  by 
any  disease  within  the  spine,  whether  effusion,  tumour, 
or  exostosis.  Diseases,  too,  within  the  cranium,  by  irri- 
tating the  excitor  nerves,  will  induce  epilepsy — too  fre- 
quently, alas  !  of  an  incurable  character. 

Diagnosis. — Epilepsy  is  sometimes  confounded  with 
apoplexy  and  hysteria.  In  epilepsy  you  have  violent 
convulsions,  in  apoplexy  almost  motionless — in  epilepsy, 
the  paroxysm  short  and  face  pale — quite  the  reverse  in 
apoplexy.  During  the  stage  of  coma,  there  may  be 
some  difficulty. 

In  regard  to  hysteria,  there  can  be  no  difhculy  in  dis- 
tinguishing epilepsy;  in  epilepsy,  there  is  generally  a 
complete  loss  of  sense;  in  hysteria,  quite  incomplete, 
and  in  this  latter  you  usually  have  laughing,  crying, 
sobbing,  &c. 

There  is  some  difficulty,  at  times,  in  distinguishing 
epilepsy  from  the  convulsions  of  children?  arising  from 
dentition  or  intestinal  irritation ;  they  cannot  be  looked 
upon  as  epileptic,  though  it  might  be  difficult  to  decide 
in  what  respect  the  convulsions  differed  in  the  two 
cases. 

Prognosis. — If  the  cause  be  evident,  and  is  of  a  re- 
movable nature,  not  dependent  on  any  organic  disease, 
and  met  at  its  commencement,  there  is  reason  to  believe 
it  may  be  cured.    A  distinguished  author  asserts,  that 


EPILEPTIC  FITS. 


419 


cures,  sometimes,  also  take  place  in  cases  of  considerable 
duration ;  and  there  is  no  reason  to  despair  in  any  case, 
unless  obviously  connected  with  incurable  organic  dis- 
ease, or  evidences  of  deterioration  in  the  condition  of 
the  brain. 

Those  cases  which  commence  in  early  infancy,  are 
generally  very  unfavorable. 

If  you  cannot  discover  the  cause,  the  prognosis  must 
be  unfavorable.  The  disease,  altogether,  is  one  of  the 
most  intractable  we  can  have  to  treat.  It  is  a  disease 
which,  in  a  large  majority  of  cases,  cannot  be  cured, 
though  in  most  cases  we  may  lessen  it. 

Treatment. — In  regard. to  this,  no  course  of  treatment 
can  be  exclusively  relied  on  in  all  cases.  Sometimes 
the  attack  is  sudden  :  at  others,  the  warning  is  afforded ; 
in  this  latter  case,  it  would  be  advisable  to  attempt  an 
impression  on  the  nervous  system.  The  treatment 
naturally  divides  itself  into  that  which  is  required 
during  the  paroxysm,  and  that  which  is  necessary  during 
the  intervals. 

Where  you  have  the  warning,  it  might  be  useful  to 
attempt  an  impression  upon  the  nervous  system,  by  the 
administration  of  an  opiate  in  a  large  dose,  and  for  this 
purpose  opium  should  be  selected. 

In  the  paroxysm,  very  little  treatment  is  demanded ; 
in  fact,  nothing  can  be  done  of  service,  unless  it  be  to 
elevate  the  head,  and  keep  him  from  injuring  himself 
from  his  own  convulsive  movements.  Place  some  sub- 
stance between  his  teeth ;  you  may  apply  cold  water  to 
the  head ;  and  it  is  said  to  do  good  to  put  salt  and  water 
in  the  mouth. 

If  there  is  an  exciting  cause,  it  must  be  removed,  if 
possible ;  if  j  ou  can  ascertain  none,  I  then  adopt  an 


420 


EPILEPTIC  FITS. 


antiphlogistic  treatment.  I  advise  the  patient  to  abstain 
from  all  kinds  of  wine  and  liquors,  to  live,  if  possible, 
on  nothing  but  a  milk  diet  and  gruel,  or  at  least  vege- 
table substances;  avoid  meat.  Keep  the  bowels  in  a 
very  soluble  condition,  and  administer  a  shower  bath 
upon  the  head,  at  least  twice  a  day. 

I  introduce  a  seton  in  the  nape  of  the^  neck ;  and  a 
recent  French  author  affirms  that  he  has  cured  epilepsy 
by  severe  cauterizations  with  caustic  potash  on  each  side 
of  the  spine  of  the  neck  and  back;  he  makes  fresh  cau- 
terizations every  five  or  six  weeks. 

All  sensual  excesses,  including  the  habit  of  masturba- 
tion, must  be  abandoned.  I  was  consulted  by  a  patient 
a/ew  days  ago,  who  resides  at  Montgomery,  and  I  traced 
it  to  onanism,  and  so  long  as  he  would  abandon  this 
pernicious  and  horrible  practice,  he  was  exempt;  but 
my  friend  Dr.  Arnold  informed  me  that  he  thought 
there  was  not  much  prospect  of  controlling  him.  I 
believe  in  such  cases  it  would  be  well  to  give  dulca- 
mara, as  an  antiphrodisiac  remedy,  (medicines  capable  of 
blunting  the  venereal  appetite.) 

That  class  of  remedies  styled  tonic  have  been  more 
extolled  of  late  in  the  treatment  of  epilepsy  than  any 
other.  We  shall,  however,  in  the  first  place,  allude  to 
those  vegetable  preparations  which  enjoy  the  confidence 
of  a  very  large  portion  of  the  profession.  Among  this 
class  of  remedies,  indigo,  of  late,  has  attracted  consider- 
able attention;  it  is  given  in  twenty  grain  doses, 
increased  to  a  drachm  or  a  drachm  and  a  half  per  day; 
it  must  be  persevered  in  for  months. 

Dr.  Henry  recommends  very  highly  the  stramonium, 
(Jamestown  weed.)  Take  a  pound  of  the  green  leaves, 
mash  them,  press  out  the  juice,  put  it  into  an  open  ves- 


EPILEPTIC  FITS. 


421 


sel,  place  it  in  the  sun  until  you  can  make  pills  from  it. 
He  makes  the  pills  to  contain  two  grains.  First  give 
an  emetic,  and  then  a  pill  night  and  morning. 

I  have  used  the  miseltoe  taken  from  off  the  water 
oak,  (it  should  be  collected  in  November,  dried  and  pul- 
verized, and  kept  in  a  close  bottle,)  in  doses  from  thirty 
to  fifty  grains,  gradually  increasing  to  two  drachms,  two 
or  three  times  a  day.  It  is  a  valuable  remedy.  Some 
prefer  administering  it  in  an  infusion  of  valerian. 

The  garden  peony,  quinine,  lady  slipper,  snake  root 
and  capsicum  are  all  extolled ;  and  when  the  paroxysm 
is  of  regular  periodicity,  I  would  rely  much  on  some  of 
these  remedies. 

The  tonics  of  the  mineral  kingdom  are  most  generally 
preferred.  Andral  speaks  in  high  terms  of  the  nitrate  of 
silver.    He  uses  the  following  : 

1^.    Nitrate  of  silver,  (lunar  caustic,)  grs.  vi. 
Ex.  of  opium,  oi. 
Musk,  9ii. 
Camphor,  9iv. 

Mix,  and  divide  into  90  pills;  he  gives  one  night  and 
morning,  gradually  increasing  the  dose.  It  is  said  that 
nitrate  of  silver  has  a  tendency  to  produce  discoloration 
of  the  skin,  and  from  this  fact  the  remedy  should  not  be 
given  longer  than  a  month. 

The  preparations  of  copper  have  been  used  with  ben- 
efit, as  also  the  sulphate  and  oxide  of  zinc,  others  extol 
the  preparations  of  iron ;  but  besides  these,  which  in 
truth  may  be  deemed  a  rational  treatment,  there  are  cer- 
tain specific  remedies  in  this  disease  which  we  employ 
empirically.  They  do  good,  we  have  no  doubt,  in  many 
instances,  without  our  being  able  to  assign  a  reason  for 


422 


EPILEPTIC  FITS. 


it.  The  following  recipes  are  prescribed  in  many  in- 
stances with  success.    The  copper  is  extensively  used. 

1^.    Cupri.  acetat.,  (verdigris,)      grs.  v. 

 sulphat.,  (blue  vitriol,)  grs.  v. 

 ammoniat,  grs.  v. 

Ext.  gentian,  3i. 
Mix,  and  divide  into  20  pills.    Dose. — One  three 
times  a  day.    The  dose  may  be  gradually  increased, 
watching  the  effects  upon  the  digestive  organs. 

A  prescription  highly  extolled  by  a  German  physi- 
cian, is — 

1^.    Ammoniated  copper,         grs.  2  to  4. 
Powdered  belladonna  root,  grs.l  to  4. 
Sugar,  5i. 
Mix,  and  divide  into  six  powders,  one  to  be  taken 
every  two  hours. 

Dr.  Dunglison  recommends  ammoniated  iron,  3i>  and 
extract  of  gentian,  9ii;  divide  into  twenty  powders. 
Dose,  one  or  two,  and  increase  to  five  or  six. 

I  have  used  the  Prussian  blue,  but  my  experience  is 
not  as  favorable  as  some  others.  The  following  is  the 
recipe :  + 

Ify.    Prussian  blue,  grs.  xii. 

Sugar,  Si- 
Mix,  and  divide  into  twelve  powders.    Give  one  every 
two  hours. 

A  favorite  of  Dr.  Ellis,  is — 

1^.    Oxide  of  zinc,  9ii. 
Conserve  of  roses,  sufficient. 


EPILEPTIC  FITS. 


423 


Mix,  and  divide  into  ten  pills.    Give  one  three  or  four 


times  a  day. 

Chloride  of  zinc,  3iv. 

Alcohol,  fl.  Si. 

Sulphuric  ether,  fl.  Sii. 


Mix.  Give  five  drops  every  hour  in  a  little  sugar 
and  water,  gradually  increasing  the  dose. 

The  artemisa  vulgaris,  or  (mugwort,)  where  there  is 
no  organic  disease,  is  highly  spoken  of  by  the  German 
journals  as  an  anti-epileptic.  They  give  from  fifty  to 
seventy  grains  a  half  hour  before  the  paroxysm. 

The  compound  powder  of  valerian  at  one  time  enjoyed 
much  reputation  in  epilepsy ;  it  was  given  as  follows  : 
^.    Powd.  valerian,  5i- 
Orange  leaves,  9i. 
Muriate  of  amoniae,  (Sal.  ammoniaa,)  grs.  ii. 
Oil  of  Cajeput,  gtts.  iv. 

Mix.    Give  tea-spoonful  four  times  a  day  in  hot  tea. 

In  the  uncomplicated  form  of  epilepsy,  digitalis  is 
entitled  to  consideration. 

The  cotyledon  umbilicus,  (navel  wort)  has  recently 
been  recommended  for  the  cure  of  epilepsy,  and  from  the 
great  success  attending  its  administration,  as  reported 
by  numerous  physicians,  it  certainly  deserves  some 
degree  of  confidence  from  the  profession. 

The  j  uice  if  given  in  one  drachm  doses,  two  or  three 
times  a  day ;  or,  if  evaporated  into  an  extract,  five  grains, 
gradually  increasing  the  dose,  if  the  patient  will  bear  it. 

A  remedy  that  is  entitled  to  great  consideration  from 
the  profession  for  the  cure  of  this  disease,  is  the  marsh 
smallage ;  it  is  a  very  dangerous  and  poisonous  remedy. 
Ten  or  twenty  grains,  according  to  the  patient's  age, 


424 


APOPLEXY. 


repeated  every  five  hours,  and  after  a  time  gradually 
augmented,  have  cured  several  cases  of  epilepsy. 

APOPLEXY. 

This  is  a  disease  originating,  in  my  opinion,  most 
generally  within  the  cranium,  and  depending  upon  pres- 
sure upon  the  brain.  If  a  person  be  walking  or  sitting, 
he  suddenly  falls,  and  frequently  dies  immediately. 

Symptoms. — It  is  most  usually  preceded  by  drowsi- 
ness ;  a  heavy  unpleasant  sensation  is  felt  in  the  head 
for  a  great  length  of  time  before  the  attack  comes  on. 
It  is  asserted  not  to  be  uncommon  for  persons  before  they 
become  apoplectic,  to  have  numbness  of  the  fingers,  or 
of  some  part  of  the  body.  After  the  attack,  if  death 
does  not  take  place  speedily,  the  pulse  is  very  slow, 
sometimes  full,  and  others  very  feeble ;  the  face  is  livid 
and  flushed,  and  most  generally  swollen.  The  attack 
generally  lasts  but  a  few  minutes,  although  there  are 
cases  reported  where  it  has  lasted  for  hours  and  days ; 
in  this  latter  variety  they  seldom  react  out  of  it. 

When  the  disease  does  not  terminate  in  instant  death, 
the  symptoms  generally  recede  till  they  disappear  alto- 
gether. Consciousness  and  observation  of  things  return, 
and  yet,  sometimes  the  return  is  not  perfect.  Power, 
consciousness,  and  perception  return,  except  in  one  part 
of  the  body ;  so  that,  after  the  disease,  one  half  of  the 
body  very  frequently  remains  motionless,  without  being 
at  all  subject  to  the  volition  of  the  patient ;  and  some- 
times, in  addition  to  this  loss  of  power  over  half  the  body, 
there  is  also  a  loss  of  sense,  at  least,  with  regard  to 
touch. 

There  is  a  peculiarity  in  regard  to  the  eye ;  if  the 


APOPLEXY. 


425 


pupil  is  dilated;  there  is  a  good  prospect  for  recovery; 
if  contracted,  the  chances  are  much  diminished. 

Patients  not  unfrequently  recover  from  an  attack  of 
apoplexy,  yet  they  are  peculiarly  liable  to  a  return  of 
the  disease,  "  which  in  general  sooner  or  later  proves 
fatal."    They  very  seldom  survive  the  third  attack. 

In  some  instances,  with  care  the  disease  may  be 
removed.  It  most  generally  attacks  sedentary  persons 
and  those  who  use  a  rich  diet  and  indulge  in  ardent 
spirits  freely. 

( 1auses. — It  was  at  one  time,  and  very  generally,  sup- 
posed, that  a  certain  peculiar  formation,  tended  much  to 
apoplexy ;  for  instance,  persons  who  have  large  heads, 
short  necks,  red  faces,  and  a  full  habit  of  body,  are 
thought  to  be  peculiarly  liable  to  the  disease,  if  there  is 
an  hereditary  disposition,  then  they  may  be  peculiarly  so. 

A  distinguished  author  observes,  men  who  have  large 
thick  heads,  are  those  that  are  usually  afflicted,  because 
that  is  not  the  shape  for  intellect.  (It  is  a  long  headed 
man  that  is  generally  thought  clever,  and  such  is  the  fact. 
I  have  a  friend  who  has  what  I  term  a  front  and  back 
room  to  his  head,  and  he  is  a  very  clever,  good  natured 
man.)  This  same  author  contends,  that  men  possessing 
the  physical  formation  I  have  described,  are  certainly 
very  liable  to  apoplexy.  The  immediate  cause  of  apo- 
plexy, is  a  compression  of  the  brain,  occasioned  by  an 
excess  of  blood,  and  frequently  the  result  of  a  collection 
of  watery  humours. 

"The  former. is  called  a  sanguine,  and  the  latter  a 
serous  apoplexy.  It  may  be  occasioned  by  any  thing 
that  increases  the  circulation  towards  the  brain,  or  pre- 
vents the  return  of  blood  from  the  head :  as  intense 
study;  violent  passions;  wearing  anything  too  tight 


426 


APOPLEXY. 


about  the  neck ;  a  rich  and  luxurious  diet ;  suppression 
of  urine ;  suffering  the  body  to  cool  suddenly,  after  having 
been  greatly  heated ;  continuing  long  in  a  warm  or  cold 
bath;  excess  of  venery ;  the  sudden  striking  in  of  an 
eruption ;  stoppage  of  any  customary  evacuation;  wounds 
or  bruises  on  the  head ;  and  long  exposure  to  excessive 
cold." 

Treatment — If  the  disease  is  the  result  of  pressure  of 
a  piece  of  bone,  then  you  require  the  surgeon,  and  it 
would  be  great  and  extreme  folly  to  administer  medicine. 
If  it  be  an  ordinary  case  of  apoplexy,  the  indication 
will  be  to  check  the  haemorrhage  and  reduce  congestion ; 
his  head  and  shoulders  should  be  elevated,  and  his  neck 
should  be  unincumbered ;  he  should  have  fresh  air,  and 
no  one  but  his  attendants  should  be  about. 

If  the  face  is  red,  and  there  is  evident  congestion  upon 
the  brain,  and  the  pulse  full,  then  I  advise  bleeding,  and 
to  an  extent  proportionate  to  the  vigor  of  the  patient, 
and  the  force  of  the  circulation.  In  the  first  place,  I 
generally  pour  cold  water  upon  the  head  for  some  little 
time,  in  a  constant  stream,  and  this  frequently  accom- 
plishes all  that  you  could  expect  from  the  lancet — if  it 
reduces  the  action  of  the  heart,  and  the  pulse  should  be 
small,  you  must,  under  no  consideration,  use  the  lancet. 
Some  commend,  in  high  terms,  the  use  of  cupping  to 
the  nape  of  the  neck  and  temples,  when  the  pulse  is 
feeble. 

After  you  have  tried  the  cold  water,  then  the  practi- 
tioner should  be  guided  by  the  strength  of  the  pulse, 
whether  he  shall  bleed  or  not ;  and  by  this,  in  connexion 
with  the  general  state  of  the  constitution  of  the  patient, 
to  what  extent  he  shall  bleed. 

You  should  then  administer  a  full  dose  of  purgative 


APOPLEXY. 


427 


medicine ;  for  this  purpose  give  one  or  two  drops  of  cro- 
ton  oil,  in  combination  with  a  strong  infusion  of  senna, 
if  he  can  swallow ;  if  deglutition  is  difficult,  place  the 
croton  oil  on  his  tongue,  without  waiting  for  the  action 
of  this  cathartic.  You  should  give  a  strong  and  acrid 
cathartic ;  I  would  advise  an  infusion  of  the  extract  of 
colocynth,  in  combination  with  castor  oil. 

Water  should  be  kept  constantly  applied  to  the  head, 
and  ice,  if  it  can  be  procured ;  revulsion  to  the  extremi- 
ties should  be  kept  up  by  mustard  foot  baths ;  and  sina- 
pisms (mustard  plasters)  should  be  applied  to  the  feet 
and  legs ;  if,  under  the  application  of  water  to  the  head 
and  plasters  to  the  extremities,  the  surface  should  be- 
come cool,  the  face  pale  and  the  pulse  feeble,  you  must 
stop  the  cold  applications,  and  substitute  warm  emol- 
lient ones. 

If  the  force  of  the  circulation  has  been  reduced,  and 
the  comatose  symptoms  still  remain,  then  I  would  advise 
the  use  of  podophyllin,  in  small  doses,  for  its  constitu- 
tional effect.  Some  recommend  shaving  the  head,  and 
applying  a  blister  over  the  whole  scalp ;  this  produces  a 
powerful  exterior  revulsion,  and  may,  I  have  no  doubt, 
allay  any  tendency  there  may  be  to  inflammation. 

Great  care  must  be  taken  not  to  push  any  treatment 
too  far ;  for  there  can  be  no  question  that  persons  will 
sink  after  a  time,  entirely  from  these  measures  being 
pushed  to  too  great  an  extent. 

Attention  must  be  paid  to  the  urinary  organs,  and  the 
catheter  used,  if  necessary. 

Diet. — It  should  consist  of  farinaceous  and  demulcent 
drinks,  and  in  extreme  prostration  give  beef  tea. 

Prophylactic  Treatment. — I  find,  in  an  author  of  great 
repute,  a  prophylactic  treatment  recommended,  which 


428 


WHOOPING  COUGH. 


coincides  with  my  views.  His  bowels  should  be  kept 
regularly  open  once  a  day;  and  if  any  tendency  to  con- 
stipation exists,  he  should  occasionally  take  a  small  dose 
of  sulphate  of  magnesia  or  some  other  saline  cathartic. 
Should  vertigo  or  headache,  flushed  face,  full  pulse, 
come  on  at  any  time,  no  hesitation  should  exist  in  taking 
blood  locally,  and  applying  cold  water  to  the  head,  and 
I  would  advise  cold  water  injection.  Stimulating  drinks' 
and  condiments  should  be  wholly  proscribed ;  tea  and 
coffee  should  not  be  used.;  his  diet  should  consist  chiefly 
of  vegetable  food  and  milk,  with  boiled  meats  in  mode- 
ration. He  should  never  strain,  walk  fast,  or  run ;  he 
should  avoid  all  active  muscular  exertion.  He  should 
sleep  on  a  mattrass,  with  the  head  high,  and  never  suffer 
himself!  to  become  excited. 

PERTUSSIS. 

Whooping  Cough. — It  is  so  called  from  the  peculiar 
noise  attendant  upon  the  cough ;  it  is  a  contagious  dis- 
ease, and  most  frequently  attacks  young  children. 

Symptoms. — If  you  have  once  seen  the  disease  you 
will  ever  after  know  it ;  it  makes  its  appearance  similar 
to  a  common  cold,  and  this  always  precedes  the  disease ; 
you  soon  have  red  and  watery  eyes,  sneezing,  a  dry 
cough,  and  sometimes  slight  fever ;  and  at  this  period 
you  cannot  distinguish  it  from  cold.  It  is  soon  followed 
by  violent  fits  of  coughing,  with  short  expirations,  the 
fits  of  coughing  are  in  quick  succession,  and  then  gene- 
rally followed  by  one  deep,  long  whooping  or  crowing 
inspiration. 

About  this  period  the  disease  begins  to  manifest  a 
convulsive  or  spasmodic  character;  the  duration  of  the 
fits  of  coughing  are  increased,  and  in  violent  cases  the 


WHOOPING  COUGH. 


429 


cough  is  at  times  exceedingly  troublesome.  We  have 
seen  paroxysms  of  coughing  hist  ten  minutes,  during 
which  time  the  face  is  flushed  and  swollen,  the  veins  of 
the  neck  and  temple  distended,  the  eyes  very  prominent, 
and  the  whole  countenance  expressive  of  much  distress ; 
every  muscle  seems  put  into  action,  and  the  child  appa- 
rently about  to  be  strangled — in  a  few  minutes  it  will 
run  and  play  as  if  nothing  were  the  matter.  Fewest  is 
not  essentially  connected  with  this  disease,  although  in 
many  instances  we  find  it;  when  it  is  inflammatory,  the 
spasmodic  cough  will  frequently  continue  even  for 
months  after  that  state  has  subsided. 

The  force  of  the  disease  varies  much ;  in  protracted 
cases  great  emaciation  and  debility  sometimes  ensue, 
and  the  patient  frequently  dies  of  exhaustion-.  The 
simple  or  mild  form  of  the  disease  generally  terminates 
favorably ;  it  is  peculiarly  liable  to  complications,  which, 
are  not  only  dangerous  but  frequently  very  fatal;  those 
diseases  most  frequently  in  combination  are  pneumonia, 
bronchitis  and  croup,  this  latter  is  much  to  be  dreaded, 
and  will  require  great  care  and  watchfulness. 

Treatment. — In  simple  cases,  or  more  properly  speak- 
ing, mild  cases,  very  little  treatment  is  necessary. 

In  the  early  or  catarrhal  stage,  we  general!}  ad- 
minister castor  oil,  but  if  there  be  fever,  I  immedi- 
ately give  ipecac,  and  push  it  to  vomiting;  the  oil 
should  be  repeated  every  three  hours,  until  the  bowels 
are  freely  opened. 

When  the  spasmodic  symptoms  appear  different  reme- 
dies are  required.  Some  prefer  the  nervous  stimulants 
or  anti-spasmodics,  and  the  narcotics  have  been  found 
useful;  these  remedies  are  not  indicated  if  there  be 
fever. 


430 


"WHOOPING  COUGH. 


Emetic  remedies  I  have  found  very  useful,  they  relax 
the  spasm,  produce  nausea  sufficient  to  depress  the 
arterial  excitement,  and  assist  expectoration.  I  advise 
small  doses  of  ipecac,  to  be  frequently  repeated,  suffi- 
ciently often  to  keep  the  system  under  its  influence ; 
any  of  the  anti-spasmodics  can  be  combined  with  this 
beneficially  when  the  fever  has  disappeared. 

There  are  a  great  variety  of  remedies  used;  the 
black  cohosh  we  have  used  with  decided  advantage. 
Dr.  King  reported  it  to  the  New  York  Philosophical 
Journal  of  1844  ;  he  recommends  the  saturated  tincture 
to  be  given  from  five  to  ten  drops,  increasing  every  two 
hours.  I  have  used  it  in  from  ten  to  fifteen  drops  three 
or  four  times  a-day,  to  a  child  a  year  old. 

I  have  tested  of  late  nitric  acid,  it  can  be  given  to  a 
child  of  any  age ;  and  it  is  unquestionably  very  prompt 
in  its  action.  Make  a  solution  as  strong  as  lemon  juice, 
sweeten,  and  give  small  portions  two  or  three  times  a- 
day ;  some  of  the  physicians  of  New  Orleans  speak  in 
high  terms  of  it. 

Of  the  narcotic  remedies,  belladonna  enjoys  the 
highest  reputation  in  this  disease,  with  the  most  of 
American  practitioners  ;  you  will  derive  little  good  from 
it  until  the  system  is  fully  impressed  with  its  action, 
this  will  be  manifest  when  you  have  dryness  of  the 
throat  and  vertigo ;  you  can  use  either  of  the  following 
recipes : 

Extract  of  belladonna,  9ii. 
Distilled  water,  £ii. 

Dissolve  and  filter,  then  add,  syrup,  3  lbs. ;  boil  and 
strain,  and  ffive  from  one  to  three  drachms ;  or, 


WHOOPING  COUGH. 


431 


1^.    Dried  belladonna  leaves,  5i. 
Digitalis, 

Common  nightshade,  aa.  5l 
Water,  fl.gx. 
Digest  for  two  or  three  days,  filter  and  add  syrup, 
2  lbs. ;  give  a  tea-spoonful  every  hour  or  two. 

There  is  a  variety  of  other  narcotics  used  in  whoop- 
ing cough.  Among  them  is  opium,  hyosciamus,  lettuce 
and  conium.  Opium  is  a  good  remedy  to  allay  cough, 
but  its  astringent  qualities  check  expectoration.  We 
have  administered  it  in  the  following  combination  advan- 
tageously : 

^.    Wine  of  ipecacuanha,  3i. 


Tincture  Opii.,  9i. 

Carbonate  of  soda,  9i. 

Syrup,  fl.3ii. 

Water,  5ii. 


Mix.    Give  a  tea-spoonful  every  two  or  three  hours. 

Nervous  stimulants  are  highly  extolled  by  Dr.  Wood, 
and  he  advises  assafoetida  to  be  given ;  to  a  child  two 
years  old  he  gives  two  grains  three  or  four  times  a  day. 
The  following  is  a  more  preferable  mode  for  its  admin- 
istration : 

I£s.    Assafoetida,  5i. 
Water,  A.^iv. 
Make  an  emulsion,  and  add — 

Tinct.  of  balsam  of  tolu,  fl.Sss. 

 opium,  3i. 

Mix  well.  Give  tea-spoonful  every  two  hours  to  a 
child  four  years  old. 

You  will  frequently  find  it  necessary  to  substitute 
other  anti-spasmodics,  many  of  which  have  much  repu- 


432 


WHOOPING  COUGH. 


tation.  I  advise  the  following  when  the  assafoetida 
fails  or  cannot  be  taken  : 

Ify.    Liquid  succinate  of  ammonia, 
Elixir  of  liquorice,  aa.  5ii. 
Wine  of  opium, 
Syrup  of  ipecac,    aa.  3i. 
Mix.    Give  from  twenty  drops  to  half  tea-spoonful 
every  three  hours.  Or, 

Dissolve  carbonate  of  potash,  twenty  grains,  in  a  gill 
of  water,  add  ten  grains  of  powdered  cochineal,  sweeten 
with  loaf  sugar,  and  give  an  infant  a  tea-spoonful, 
increasing  the  dose  according  to  the  age  of  the  child. 
This  preparation  is  much  improved  by  adding  ten  or 
fifteen  drops  of  the  tincture  of  belladonna. 

The  following  anti-spasmodic  linament  is  highly 
extolled : 

Jty.    Oil  of  amber,  3ii. 

 olives,  Sss. 

Laudanum,  5ii. 
Brandy,  Shi- 
Mix,  and  rub  well  between  the  shoulders. 

There  are  other  anti-spasmodics  which  have  considera- 
ble reputation,  such  as  musk,  valerian,  castor,  and  cam- 
phor. 

It  is  necessary  that  we  should  allude  to  tonics,  some 
of  which  have  proved  highly  efficient  remedies,  and  are 
strongly  recommended;  a  very  distinguised  physician 
says  they  are  undoubtedly  occasionally  useful,  and  the 
practitioner  may  know  where  to  resort  when  he  has 
ineffectually  exhausted  the  usual  round  of  remedies. 
Where  there  is  much  debility  I  have  no  doubt  it  might, 


WHOOPING  COUGH. 


433 


to  a  great  extent,  be  counteracted  by  the  proper  admin- 
istration of  this  class  of  remedies. 

Some,  if  not  all  of  the  following,  are  highly  praised  by 
many  practitioners  : 


Powdered  Peruvian  bark, 

3ii. 

 Seneka, 

3ss. 

 Liquorice, 

Si. 

Contused  poppy  heads, 

Shi. 

 Ipecacuanha, 

Ground  ivy, 

Hyssop, 

Pennyroyal,  aa.  handful. 

Sugar,  one  pound ;  water,  sufficient. 

Boil,  and  make  a  syrup.  Give  three  table-spoonsful 
a  day. 

The  following,  it  is  said,  has  been  used  with  great 
success : 

fy.    Tinct.  of  bark,  giii. 
Paregoric  elixir,  Bss. 
Tinct.  of  Spanish  flies,  3i. 
Mix.    To  be  given  in  very  small  doses. 

The  following  is  also  extolled  as  a  tonic  remedy. 

ty.    Sulphate  of  zinc,  grs.  x. 

Powdered  myrrh,  £iss. 
Conserve  of  roses,  sufficient. 
Mix,  and  divide  into  twenty  pills.    Give  one  three 
times  a  day. 

The  preparations  of  tannic  acid,  alum,  sulphur,  and 
lead,  are  recommended,  also. 

Dr.  Maddison,  of  Virginia,  recommends  a  blister  to  the 
nucha,  or  hinder  part  or  nape  of  the  neck ;  says  he  has 
28 


434 


WHOOPING  COUGH. 


been  successful  in  curing  whooping  cough  by  these 
means.  He  recommends  this  mode,of  treatment  on  the 
theory  that  the  disease  consists  in  specific  irritation  of 
the  spinal  cord,  from  the  origin  of  the  eighth  pair  to  the 
origin  of  the  phrenic  nerve. 

Conium,  the  active  principle  of  the  poison  parsley, 
Hemlock,  is  extolled  by  the  French  physicians,  in  this 
disease ;  they  give  it  to  children  in  doses  of  from  one- 
fortieth,  to  one-tenjih  of  a  grain,  according  to  their  ages, 
from  three  months  to  four  years  of  age ;  it  is  a  dange- 
rous medicine,  and  should  never  be  used  unless  prescribed 
by  a  regular  physician. 

Coffee  is  now  being  used  with  much  success  in  this 
disease.  Dr.  Delahage  gives  the  following  formula  as 
almost  infallable : — Take  of  syrup  of  extract  of  coffee, 
four  pounds ;  extract  of  belladonna,  extract  of  ipecacu- 
anha, of  each,  two  scruples ;  mix  together.  Dose,  two 
fluid  drachms,  or  a  dessert-spoonful,  at  morning  and 
noon,  and  double  this  dose  at  night,  on  going  to  bed,  for 
children  of  three  to  five  years  old ;  it  should  be  taken  in 
two  or  three  table-spoonsful  of  warm  water. 

If  your  little  patient  should  have  convulsions,  give 
assafoetida  and  egg  as  an  injection,  and  apply  garlic 
poultices  to  the  extremities.  Dr.  Williams  says,  blow- 
ing into  the  ear,  will  control  spasms  in  a  child.  The 
bowels  should  be  kept  in  a  healthy  condition,  and  the 
secretions  corrected  by  appropriate  means.  If  the  gums 
are  swollen,  the  lancet  should  be  freely  applied  to  them. 
The  diet  should  consist  chiefly  of  vegetable  substances, 
and  I  generally  allow  milk ;  every  thing  taken  should 
be  of  easy  digestion.  The  child  should  wear  flannel 
next  to  the  skin. 


HICCOUGH. 


435 


SINGULTUS. 

Hiccough. — This  is  an  affection  of  a  spasmodic  or  con- 
vulsive character,  arising  from  any  cause  that  produces 
irritation  of  the  nervous  fibres  of  the  stomach  or  dia- 
phragm (vulgarly  called  midriff.) 

It  frequently  attends,  and  is  very  annoying,  when 
there  is  inflammation  of  the  stomach,  bladder,  or  intes- 
tines ;  we  have  seen  it  the  result  of  excess  in  eating  or 
drinking,  especially  where  the  substances  were  hard  of 
digestion.  In  malignant  fevers,  that  are  almost  termi- 
nating in  dissolution,  it  is  a  very  dangerous  symptom ; 
it  argues  unfavorably. 

It  is  said  to  be  frequently  the  result  of  scirrhus  tumors 
of  the  stomach. 

Treatment. — If  it  be  the  result  of  poison  taken  into 
the  stomach,  then  you  will  administer  freely  sweet  oil 
and  milk,  which  will  generally  give  relief. 

If  it  proceed  from  an  inflammation  of  the  stomach, 
you  will  have  to  adopt  an  antiphlogistic  course ;  cup 
freely  over  the  stomach.  In  this  form  of  disease  we 
have  given  a  few  drops  of  nitric  acid  with  decided  benefit. 
Some  recommend  spirits  of  nitre,  others,  opium ;  I  advise 
a  blister  after  the  cupping,  and  warm  fomentations  to 
the  stomach. 

When  it  is  the  result  of  indigestion,  any  alkali  will 
frequently  afford  relief.  I  have  known  a  Seidlitz  powder, 
drank  whilst  effervescing,  to  cure  a  troublesome  hic- 
cough. 

I  have  frequently  seen  cases  of  hiccough  that  proved 
very  troublesome.  In  this  class  of  cases  you  will  have  to 
administer  your  most  active  antispasmodic;  musk,  in 
large  doses,  will  be  found  useful.    Some  advise,  in  these 


436 


ST.  TITUS'  DANCE. 


cases  a  cataplasm  of  turpentine ;  I  think  I  have  derived 
more  advantage  from  morphine,  than  almost  any  other 
remedy. 

When  hiccough  is  the  result  of  flatulence,  you  will 
generally  afford  relief  by  giving  brandy  and  peppermint; 
some  advise  fennel  seed  tea.  It  is  said  that  the  com- 
mon hiccough  can  be  generally  removed  by  taking  a 
pinch  of  snuff,  or  anything  that  will  cause  sneezing. 

Mush. — A  stimulant  and  antispasmodic,  is  a  very  use-  • 
ful  remedy  in  violent  hiccough,  given  in  doses  of  from 
five  to  twenty  grains. 

CHOREA. 

St  Vitus  Dance. — It  is  characterized  by  involuntary 
contractions  of  the  muscles,  and  is  very  closely  allied  to 
paralysis  agitans ;  there  is  no  loss  of  consciousness,  in 
fact,  no  perceptible  disturbance  of  the  intellect,  unless 
the  disease  has  continued  for  a  great  length  of  time ;  it 
is  a  disease  that  seems  to  confine  itself  almost  exclu- 
sively to  young  persons. 

Sympkxms. — Chorea  generally  comes  on  gradually, 
and  is  preceded  by  irregular  appetite,  and  violent  con- 
stipation; you  will  soon  observe  that  they  have  not 
complete  control  generally  of  one  foot,  and  frequently 
there  are  catches  and  twitching  sensations  of  the  mus- 
cles of  the  neck ;  this  is  soon  followed  by  unusual  and 
ludicrous  contortions  of  the  face,  or  violent  movements 
of  the  shoulder  or  hands ;  in  fact,  there  is  almost  a  con- 
stant flexion,  extension,  or  rotation  of  these  muscles.  It 
is  said  the  disease  is  particularly  characterized  by  a 
catching  of  the  fingers.  I  do  not  think  there  is  a  com- 
plete loss  of  the  power  of  the  will,  but  the  muscles  seem 
to  be  beyond  the  control  of  the  will ;  in  a  short  time  the 


st.  Vitus'  dance. 


437 


whole  body  becomes  more  or  less  involved  in  this  mus- 
cular action.  It  is  sometimes  difficult  for  a  patient  to 
walk,  stand,  or  sit;  fear  or  mental  emotion  increases  the 
action  of  the  muscles  temporarily.  The  features  un- 
dergo the  most  peculiar  distortions,  and  frequently  spec- 
tators seem  to  be  amused  at  the  poor  sufferer.  The 
gesticulations  are  so  grotesque  and  diversified,  that  it 
would  be  exceedingly  difficult  to  name  the  various  gyra- 
tions. The  motions,  as  I  before  observed,  are  a  little 
under  the  power  of  the  will,  and  sometimes  they  can 
restrain  them  temporarily,  but  their  best  effort  in  the 
disease  is  little  more  than  a  sudden  catch. 

It  is  asserted,  in  very  bad  cases,  that  the  patient  loses 
the  power  of  maintaining  a  standing,  or"  even  sitting 
posture,  and  is  compelled  to  lie  in  bed ;  and  a  very  dis- 
tinguished author  says,  he  has  seen  cases  where  they 
could  not  even  lie  in  bed — that  it  was  necessary  to  strap 
them  down. 

It  occurs  most  frequently  between  the  ages  of  three 
and  fourteen  \  females  are  much  more  subject  to  it  than 
males;  when  the  disease  occurs  in  adults,  it  is  seldom 
relieved.  Females,  it  is  said/ are  relieved  of  it  upon  the 
establishment  of  the  menstrual  secretion. 

Nature, — In  regard  to  the  nature  of  chorea,  very  lit- 
tle, indeed,  is  known,  beyond  that  it  is  admitted  to  be  a 
functional  disease  of  the  brain,  and,  in  my  opinion,  con- 
fined to  the  cerebral  organs,  although  some  contend  that 
it  is  an  affection  of  the  spinal  marrow.  The  motions 
are  merely  voluntary,  and  are  somewhat  subject  to  the 
will,  which  might  be  considered  of  cerebral  origin ;  it  is 
sometimes  attended  with  headache,  which  is  almost  a 
positive  evidence  of  its  cerebral  locality. 

I  have  seen  eight  cases  in  Mississippi  and  Texas, 


438 


ST.  VITUS'  DANCE. 


although  I  believe  the  disease  is  little  known  in  hot 
climates. 

Treatment. — The  mass  of  authority,  at  the  present 
time,  recommend  purgative  medicine,  which  treatment, 
I  think,  originated  with  Dr.  Hamilton,  it,  at  least,  should 
have  originated  with  the  Doctor,  as  he  recommends  a 
" looseness"  indiscriminately. 

In  a  majority  of  cases,  you  will  have  headache  and 
constipation,  and  sometimes  tenderness  of  the  abdomen; 
your  first  indications  will  be  to  remove  these  symptoms 
of  disease,  independently  of  the  involuntary  actions. 

If  there  is  headache,  I  would  advise  cupping  the  tem- 
ples and  between  the  shoulders,  and  use  cold  water 
applications  to  the  head. 

If  there  be  costiveness,  it  is  our  duty  to  remove  it, 
and  it  should  be  promptly  corrected.  It  is  highly  pro- 
bable that  purgation  is  useful,  not  only  by  removing  a 
source  of  irritation  from  the  bowels,  but  also  by  acting 
revulsively  from  the  brain,  and  by  depletion  in  plethoric 
cases.  You  must  exercise  great  discrimination  in  the 
selection  of  your  cathartic,  to  suit  the  temperament  and 
condition  of  your  patient.  If  he  is  plethoric,  and  there 
is  an  inflammatory  or  congestive  state  of  the  head,  I 
would  advise  the  anti-bilious  pill,  viz : 

^.    Aloes,  Sii. 
Gamboge, 

Ext.  Eupatorium  perfoliatum,  (boneset,)  aa.  £i. 
Castile  soap,  gi. 
Ext.  Podophylline,  (mandrake,  or  may  apple,) 
Lobelia  seeds,  pulv., 

Ext.  Gentian,  aa.  gss. 

Capsicum,  (cayenne  pepper,)  Jii. 
Oil  of  cloves,  3i. 


ST.  VITUS'  DANCE. 


439 


Warm  the  extracts  until  they  are  quite  soft,  and  add 
the  dry  articles  in  fine  powder ;  mix  thoroughly  and  add 
the  oil ;  make  into  five  gr.  pills.  As  an  active  cathartic 
give  from  four  to  six. 

This  cathartic  might.be  repeated  every  third  day, 
according  to  the  strength  of  the  patient.  In  a  plethoric 
condition  of  the  system,  some  advise  senna  and  salts. 
If  there  is  too  much  acid  generated  in  the  stomach, 
accompanied  with  debility  of  the  digestive  organs,  and 
evident  symptoms  of  dyspepsia,  in  such  cases  I  would 
advise  the  sulphate  of  magnesia  or  rhubarb.  If  it  is 
accompanied  with  amenorrJioea  (suppression  of  the  men- 
ses,) you  should  administer  aloes  and  the  preparations 
of  iron,  as  suppression  of  the  menses  is  almost  univer- 
sally accompanied  with  debility.  In  regard  to  the 
biliary  secretions,  the  anti-bilious  pill  will  correct  that 
if  given  in  small  doses,  say  one  pill  night  and  morning. 
If  the  abdomen  be  swollen,  or  there  is  pain  on  pressure, 
besides  obviating  costiveness,  we  should  try  the  common 
remedies  for  inflammation. 

Where  it  is  necessary  to  give  strength,  and  add  tone 
to  the  nervous  system,  tonics,  anti-spasmodics,  or  ner- 
vous stimulants  are  indicated.  The  preparations  of  iron 
and  zinc  should  not  be  overlooked ;  the  sulphate  of  zinc 
is  mostly  used,  and  is  considered  very  efficient.  You 
can  give  two  grains  three  times  a  day,  and  gradually 
increase  the  dose.  It  is  essentially  necessary  to  use 
again  discrimination  in  the  selection  of  this  class  of 
remedies,  and  it  would  be  well  to  combine  it  with  one 
of  the  nervous  stimulants ;  and  Dr.  Young  says  there  is 
none  equal  to  eimieifuga,  (black  snake  root,)  he  says  it 
will  cure  the  disease  itself.  He  gives  from  a  half  drachm 


440 


ST.  VITUS'  DANCE. 


to  a  draclim  of  the  powder  three  or  four  times  a  day, 
continuing  it  two  or  three  weeks. 

The  sesquioxide  of  iron,  according  to  Dr.  Elliotson,  is 
a  specific,  truly,  if  it  accomplishes  what  he  says.  He 
affirms  that  he  has  cured  forty  cases  with  it — perse- 
verance is  all  that  is  required.  There  are  others  equal 
in  their  praise  of  Scutellaria  lateriflora,  (scull  cap.) 
They  say  it  has  never  failed  to  effect  a  cure.  I  do  not 
believe  in  that  absurd  doctrine  of  specifics;  but  can 
safely  say  that  I  have  tried  this  remedy  as  recommended 
by  Beach,  and  it  was  entirely  successful.  He  takes 
scull  cap,  one  ounce ;  boiling  water,  one  quart ;  strain, 
and  sweeten  with  loaf  sugar.  I  let  the  patient  drink 
freely  of  this  through  the  day,  alternating  with  a  tea  of 
velerian. 

Assafcetida  is  highly  recommended  in  many  instan- 
ces, more  particularly  when  the  disease  is  associated 
with  hysteria. 

After  the  system  has  been  depleted  by  purgatives, 
you  will  find  the  oil  of  amber,  in  doses  of  ten  drops, 
three  times  a  day,  a  valuable  remedy.  Friction,  with 
the  oil,  is  also  used  along  the  whole  course  of  the  spine 
three  or  four  times  a  day. 

In  France  they  extol  beyond  measure  the  use  of  the 
sulphur  bath.    It  should  at  least  be  tried. 

Quite  a  variety  of  other  remedies,  both  tonics  and 
narcotics,  have  been  given  with  some  degree  of  success. 
Belladonna,  opium  and  hyosciamus  have  their  advocates. 
A  very  distinguished  physician  assures  me  that  he  has 
treated  a  good  many  cases  successfully,  by  purgatives 
uutil  the  discharges  became  healthy;  he  then  adminis- 
ters musk  and  camphor,  in  the  doses  of  four  grains  of 


INFANTILE  CONVULSIONS. 


441 


each  every  four  or  five  hours,  with  an  assafcetida  ene- 
ma, (injection.) 

The  following  is  a  list  of  tonic  preparations,  that  can 
be  used  and  adapted  to  the  peculiar  condition  of  the 
patient. 

^.    Sulphate  of  copper,  (blue  vitriol,)  3ss. 
Carbonate  of  Ammonia,  3vi. 
Rub  in  a  glass  mortar  till  effervescence  ceases,  wrap 
in  bibulous  paper,  and  dry  with  a  gentle  heat.    Dose. — 
Quarter  of  a  grain  twice  a  day,  gradually  increasing  it. 

1^.  Carbonate  of  iron,  given  in  drachm  or  two  drachm 
doses  every  six  hours.  This  is  a  very  unstable  prepa- 
ration, it  should  be  combined  with  sugar,  which  pro- 
tects it  from  the  oxidizing  process. 

I^.    Oxide  of  zinc,  9ii. 

Conserve  of  roses,  sufficient. 
Mix,  and  divide  into  20  pills;  give  one  three  times  a 
day,  gradually  increasing  the  dose. 

The  iodide  of  iron  is  considered  to  answer  better  than 
any  other  chalybeate.  It  pervades  the  system  rapidly, 
and  keeps  the  secretions  in  a  very  healthy  condition,  it 
should  be  given  in  grain  doses  three  times  a  day. 

Diet. — It  should  be  nutritious  and  easy  of  digestion ; 
and  anything  that  is  calculated  to  excite  mentally 
should  be  avoided. 

CONVULSIONS. 

In  convulsions  some  contend  there  is  a  diseased  state 
of  the  muscular  tissues,  characterized  by  violent  in- 
voluntary contraction,  with  alternate  relaxation ;  it  may 
or  may  not  be  accompanied  with  derangement  of  the 
intellect  for  the  time;  it  very  seldom  becomes  the  promi- 


442 


INFANTILE  CONVULSIONS: 


nent  object  of  attention,  as  it  is  generally  attendant  on 
other  complaints.  We  have  sufficiently  noticed  it  as  a 
symptom  of  cerebral  inflammation.  But  you  frequently 
see,  it  is  true,  convulsions  which  do  not  seem  to  result 
from  any  other  disease,  though  I  have  no  doubt  they 
arise  from  irritation  in  some  part  of  the  body ;  I  will 
notice  this  variety. 

Symptoms. — Convulsions  manifest  themselves  in  vari- 
ous degrees  of  intensity;  they  occur  as  a  prominent 
symptom  in  the  course  of  many  diseases,  (as  we  have 
heretofore  alluded  to,)  and  although  occurring  at  all 
ages,  children  are  more  particularly  liable  to  them  during 
infancy ;  there  are  many  causes  they  proceed  from,  such 
as  irritation  of  the  bowels,  dentition,  (teething,)  and  they 
especially  attend  the  course  of  eruptive  fevers ;  they  are 
sometimes,  however,  connected  with  an  inflammatory 
state  of  the  head,  and  frequently  occur  in  hydrocephalus, 
(dropsy  of  the  head) .  A  very  distinguished  author  says, 
that  "  convulsions  may  either  be  preceded  by  other  signs 
of  nervous  disorder  or  may  come  on  abruptly,  without 
warning.  The  voluntary  muscles  of  all  parts  of  the 
body  may  be  affected,  or  the  spasms  may  be  confined  to 
one-half  of  the  body,  to  a  single  limb,  or  to  the  features. 
There  may  be  only  a  single  attack,  or  several  in  more 
or  less  rapid  succession.  During  the  paroxysm  the  face 
is  sometimes  pale,  sometimes  purplish  or  livid,  the  lips 
are  bluish,  the  features  often  apparently  swollen,  the 
juglar  veins  distended,  and  the  pulse  frequent  and  irregu- 
lar." Sometimes  there  is  involuntary  evacuations.  The 
duration  of  the  convulsion  is  exceedingly  variable.  It 
may  be  only  a  few  moments,  or  it  may  extend  to  hours 
and  days,  but,  in  the  latter  case,  there  is  always  some 
remission  or  intermission  of  the  convulsive  movements, 


INFANTILE  CONVULSIONS. 


443 


though  the  comatose  symptoms  continue.  The  average 
duration  of  each  paroxysm  is  generally  from  five  to 
fifteen  minutes;  as  soon  as  it  subsides  the  patient  is 
generally  disposed  to  sleep,  and  not  unfrequently  re- 
mains somewhat  comatose  for  a  longer  or  shorter  period. 

Convulsions  sometimes  end  fatally,  though  not  often, 
unless  connected  with  other  disease.  Simple,  uncompli- 
cated functional  convulsions,  are  seldom  very  dangerous. 
In  fact,  the  affection  is  itself,  probably,  in  many  instances 
a  safeguard,  by  directing  irritation  from  the  nervous 
centres  to  the  circumference.  Nevertheless,  convulsions 
may  prove  immediately  the  cause  of  death,  by  interrupt- 
ing the  due  innervation  of  the  lungs  or  heart,  and  from 
that  fact  demand  a  vigilant  attention  as  the  possible 
evidence  of  very  serious  disease. 

In  connection  with  the  causes  heretofore  assigned  for 
producing  convulsions,  we  may  add  strong  and  sudden 
emotion,  as  anger,  fear,  surprise,  excessive  artificial  heat, 
exposure  to  cold,  and  intestinal  worms.  A  cause  not 
sufficiently  appreciated,  is  the  milk  of  the  mother  or 
nurse,  this  occasionally  produces  convulsions  even  when 
one  or  both  are  apparently  healthy ;  some  contend  that 
agitating  or  exciting  emotions  will  sometimes  so  affect 
the  milk  as  to  induce  convulsions  in  'the  suckling;  a 
distinguished  author  says,  it  may  be  produced  from 
articles  of  food  or  medicine  taken  by  the  mother,  he 
knew  convulsions  in  an  infant  to  be  the  apparent  result 
of  antimonial  medicines  administered  to  the  mother; 
irritating  purgatives  frequently  have  the  same  effect  on 
the  child.  "The  practitioner  cannot  be  too  strongly 
impressed  with  the  importance  of  looking  to  the  gums 
and  to  the  alimentary  canal  of  children  as  the  seat  of 
the  cause  of  convulsions.   Too  great  vascular  fullness  or 


444 


INFANTILE  CONVULSIONS. 


excitement  may  induce  the  disease  in  those  predisposed 
to  it.  and  if,  at  the  same  time,  there  exists  peculiar 
nervous  disturbance,  convulsions  will  be  very  apt  to 
result.  Hence  their  great  frequency  in  fevers;  some 
children  never  have  an  attack  of  fever  without  con- 
vulsions." 

Diagnosis. — The  most  important  point  is  your  diag- 
nosis, and  to  determine  whether  the  convulsions  proceed 
from  a  vascular  irritation  of  the  brain,  or  from  mere 
nervous  irritation  or  depression.  In  the  former,  depleting 
remedies  are  indicated ;  in  the  latter,  anodynes  and  ner- 
vous stimulants ;  that  which  would  prove  useful  in  the 
one,  would  be  very  injurious  in  the  other. 

In  convulsions  produced  from  vascular  irritation  or 
congestion,  the  face  is  generally  flushed,  the  pulse  strong 
and  tense,  considerable  heat  on  the  surface,  and  the 
tongue  furred,  and  they  are  generally  preceded  by  febrile 
symptoms. 

When  convulsions  are  the  result  of  nervous  irritation, 
the  face  is  usually  pale,  or  if  colored,  is  so  in  conse- 
quence not  of  any  active  determination  to  the  head,  but 
of  the  interference  of  the  convulsions  with  respiration, 
and  is  rather  of  a  livid  hue  than  red ;  the  pulse  is  fre- 
quent, but  not  strong.  Upon  the  cessation  of  the 
paroxysm,  the  child,  instead  of  being  comatose  (a  pro- 
found deep  sleep)  as  in  the  former,  is,  at  most,  simply 
disposed  to  sleep,  and  it  frequently  acts  as  if  nothing 
had  happened. 

Treatment. — When  a  child  is  seized  with  convulsions, 
the  parents  and  attendants  generally  become  very  much 
alarmed,  and  expect  very  active  means  to  be  employed 
by  the  physician.  I  generally  place  the  patient  where 
it  can  have  fresh  air,  loosen  every  garment  upon  him, 


INFANTILE  CONVULSIONS. 


445 


order  warm  water.  During  the  time  of  its  preparation 
I  examine  the  gums,  and  if  there  is  the  least  irritation 
or  swelling,  I  immediately  lance  the  gums  well.  You 
should  immediately  bathe  the  extremities  in  warm 
water,  and  apply  mustard  plasters  to  the  legs  and  feet, 
and  if  the  head  is  at  all  heated,  apply  cold  water  to  it. 
You  should  immediately  give  an  active  purgative  injec- 
tion. 

Should  the  convulsion  not  yield  to  these  measures, 
you  will  immerse  the  patient  in  warm  water,  and  apply 
cold  water  to  the  head ;  and,  if  it  can  swallow,  give  an 
active  dose  of  ipecac,  or  lobelia. 

During  this  treatment,  you  should  make  investigation 
as  to  the  precise  nature  of  the  affection.  Should  the 
face  be  turgid  and  red,  and  the  pulse  full  and  strong, 
and  other  symptoms  indicating  active  congestion,  I  then 
advice  blood  to  be  taken  immediately;  bruised  garlic 
should  be  applied  to  the  stomach  and  feet,  made  into  a 
poultice,  and  vinegar  and  water  to  the  head.  After  the 
action  of  the  purgative  enema,  I  would  advise  the  syrup 
of  poppies  or  paragoric  to  be  given.  A  distinguished 
physician  assures  me  that,  in  this  variety,  he  gives  an 
emetic  of  ipecac. ;  says  it  frequently  puts  an  end  imme- 
diately to  the  convulsion,  and,  in  cases  of  congestion,  it 
is  best  to  give  it  after  depletion. 

If  the  ease  is  simply  one  of  nervous  irritation,  anti- 
spasmodics will  be  found  useful  in  connexion  with  the 
other  remedies.  Here  the  garlic,  as  prescribed,  is  a 
good  remedy,  and  a  mixture  of  oil  of  amber,  olive  oil, 
brandy,  and  laudanum,  may  be  rubbed  warm  along  the 
spine  and  over  the  abdomen ;  and,  in  this  stage,  some 
use  assafcetida,  musk,  oil  of  turpentine,  or  oil  of  amber, 
either  one  of  them  as  an  injection. 


V 


446  INFANTILE  CONVULSIONS. 

If  the  enema  fails  to  operate  speedily,  you  should 
immediately  give  castor  oil,  if  the  patient  can  swallow. 

In  the  cases  of  irritation  producing  the  convulsion, 
besides  removing  the  cause,  (which  is  an  important 
part  of  the  treatment,  and  should  be  looked  to  in  all 
cases ;  for  instance,  if  there  be  loorms,  oil  of  wormseed 
or  turpentine  would  be  indicated,)  you  should  diminish, 
if  possible,  the  nervous  susceptibility  to  the  disease ;  for 
this  purpose  you  can  administer  the  tincture  of  lachtca- 
rium  (wild  lettuce).  Some  think  opium  more  effica- 
cious ;  but,  before  you  administer  narcotics,  you  should 
be  well  satisfied  that  the  convulsions  are  the  result  of 
nervous  irritation ;  for,  if  given  where  there  was  active 
congestion  of  the  brain,  great  harm  might  ensue. 

You  will  very  seldom  find  any  biliary  derangement 
in  young  children ;  if  there  should  be,  I  advise  the  use 
oileptandrin,  (a  resinous  principle  of  leptandra  virginicae) 
as  superior  to  all  other  remedies  with  children ;  its  effects 
on  the  liver  are  peculiar. 

The  following  preparations  are  all  beneficial  in  con- 
vulsions : 

fy.  Garlic, 

Lard ;  equal  parts. 
Rub  well  together ;  used  on  the  extremities  as  a  revul- 
sive. 

fy.    Assafcetida,  gii. 
Opium,  grs.  ii. 

Infusion  of  chamomile,     (  giv. 
Mix.    Use  a  portion  as  an  injection,  when  the  con- 
vulsions are  violent. 

The  best  preparation  I  have  ever  used,  as  an  enema, 
is  the  following : 


CRAMP. 


447 


3$j.    Musk,  grs.  xii. 

Sugar,  '* 

Spirit  of  ammonia,  (hartshorn,)  gtts.  xxx. 
Infusion  of  flaxseed,  £iv. 
Mix,  and  inject. 

When  the  convulsions  of  children  occur  during  the 
process  of  teething,  two  grain  doses  of  marsh  smallage, 
will  prove  almost  immediately  beneficial. 

Antispasmodic  Tincture. — This  valuable  preparation 
should  always  be  in  the  possession  of  every  family,  as  it 
is  not  only  useful  in  convulsions,  but  a  certain  remedy 
in  cramps,  spasms,  tetanus,  &c. 

To  make  the  preparation  you  take  of  lobelia,  cayenne 
pepper,  and  skunk  cabbage  root,  each,  in  powder,  two 
ounces ;  diluted  alcohol,  one  pint.  Macerate  for  sixteen 
days  and  express  and  filter  through  paper.  - 

This  tincture  may  be  made  by  combining  together 
equal  parts  of  the  saturated  tinctures  of  lobelia,  cayenne, 
and  skunk  cabbage  root.  Dose,  half  to  a  tea-spoonful 
every  ten  or  twenty  minutes,  or  as  often  as  required. 

TETANUS. 

Cramp. — There  is  a  constant  stretching  and  spasm  in 
this  disease,  and  the  muscles  are  in  a  state  of  rigid,  lasting 
contraction ;  seems  to  be  confined  to  certain  voluntary 
muscles,  not  alternating  with  relaxation ;  yet  the  cramp 
and  rigidity  is  more  violent  at  one  time  than  another ;  it 
is  accompanied  by  violent  and  excruciating  pain,  and 
the  muscles  that  are  cramped  are  very  hard ;  it  is  sel- 
dom attended  with  any  disturbance  of  the  brain. 

These  spasms,  which  chiefly  affect  the  muscles  of  the 
neck,  jaw,  and  trunk,  have  had  different  names  con- 


448 


CRAMP. 


ferrecl  upon  their  tetanic  condition.  Thus,  when  they 
affect  the  jaw,  that  variety  is  styled  trismus ;  where 
there  is  a  curvature  of  the  body  backwards,  and  arched, 
this  state  is  denominated  "  opesthotonos ;"  when,  on  the 
other  hand,  the  body  is  drawn  forward,  it  is  called 
"  emprostlwtonos  ;"  when  drawn  to  one  side  it  is  termed 
a  pleurostliotonos"  The  first  and  last  are  decidedly  the 
most  common;  these  conditions  are  now  treated  as 
symptomatic  diversities  of  the  same  disease. 

There  is  quite  a  variety  of  opinion  amongst  authors 
in  regard  to  the  division  of  tetanus.  Some  use  the 
terms  "  general"  and  "  local,"  others,  "  acute"  and  "  chro- 
nic f  it  can  only  legitimately  be  divided  into  two  dis- 
tinct varieties,  and  I  think  they  are  correctly  styled, 
"idiopathic"  and  "symptomatic;"  the  first  arising,  in 
my  opinion,  from  causes  acting  directly  or  indirectly  on 
the  nervous  system,  without  any  known  condition,  patho- 
logically; the  latter  from  irritation  in  other  organs, 
affecting  indirectly  the  nervous  centres.  When  origina- 
ting from  wounds  or  other  injuries,  it  is  termed  "  trau- 
matic," and  belongs  to  the  latter  variety. 

Symptoms. — There  is,  indeed,  quite  a  multiplicity  of 
symptoms  laid  down  by  authors  which,  they  contend, 
precede  an  attack  of  traumatic  tetanus ;  this  is  not  alto- 
gether in  accordance  with  my  experience ;  I  have  had 
them  complain  of  pain  in  the  wounded  limb,  and  slight 
chilly  sensations.  The  attack  generally  comes  on  with 
an  uneasy  feeling  in  the  neck;  the  muscles  of  the  face 
soon  become  affected,  the  nose  contracted,  the  eyelids' 
fixed;  sometimes  the  jaw  "pops"  together  and  the 
tongue  is  frequently  bit ;  at  other  times  there  is  an  un- 
usual rigidity  about  the  muscles  of  the  jaw,  to  such  an 
extent  it  is  with  difficulty  the  mouth  can  be  opened ;  in 


CRAMP. 


449 


this  state  there  is  generally  difficulty  in  swallowing. 
The  diaphragm  (or  what  is  vulgarly  termed  the  mid- 
riff) is  most  always  affected,  on  which  account  there  is 
violent  and  acute  pain  in  the  region  of  the  stomach, 
accompanied  with  shortness  of  breath ;  it  soon  involves 
the  abdominal  and  recti  muscles — the  latter  are  very 
prominent  in  all  of  their  departments — it  soon  extends 
to  the  limbs,  and  very  soon  involves  all  of  the  voluntary 
muscles  of  the  body,  more  or  less. 

The  least  motion  frequently  excites  these  violent 
spasms.  They  are  at  first  slight,  and  most  frequently 
at  considerable  intervals,  but  they  increase  gradually  in 
frequency  and  violence,  until  the  succession  becomes  so 
rapid  that  the  system  has  not  time  to  relax  before 
another  paroxysm  comes  on. 

The  pulse  is  generally  small,  feeble  and  irregular,  and 
is  in  proportion  to  the  violence  and  intensity  of  the 
affection;  from  the  violent  muscular  action,  there  is 
generally  a  profuse  perspiration. 

Duration. — In  regard  to  this,  it  may  terminate  fatally 
in  less  than  twelve  hours,  or  it  may  last  many  weeks ; 
the  greater  number  die  between  the  first  and  fifth  day; 
if  they  survive  beyond  this  their  chances  for  recovery 
are  very  good.  When  they  do  die  it  is  generally  during 
the  violence  of  the  cramps,  or  from  being  completely 
exhausted  from  their  effects.  The  mental  faculties  are 
seldom  disturbed,  the  bowels  always  costive. 

If  the  patient  becomes  convalescent,  his  recovery  is 
slbw  and  gradual. 

Causes. — It  is  said  to  be  peculiar  to  hot  climates  and 
warm  seasons.  I  have  no  doubt  there  is  a  peculiar 
predisposition  requisite  to  the  production  of  tetanus,  and 
this  may  be  a  peculiar  state  of  that  part  of  the  brain  or 
29 


450 


CRAMP. 


spinal  marrow  which  is  directly  connected  with  the 
nerves  of  the  voluntary  muscles.  Whatever  the  exci- 
ting cause  may  be,  few  are  attacked,  and  the  predispo- 
sition is  unknown,  and  most  probably  will  remain  so. 

Of  the  exciting  causes,  generally,  the  most  common 
are  wounds ;  and  it  seems  to  make  but  little  difference  as 
to  the  condition  of  the  wound,  whether  healthy  or 
unhealthy,  before  or  after  suppurition,  in  the  process  of 
healing,  or  after  the  healing  has  been  completed,  he  is 
liable  to  lock-jaw  from  a  wound  for  at  least  twenty- 
eight  days. 

The  slightest  causes  sometimes  produce  the  disease, 
and  again  the  severest  injuries  often  fail  to  do  it.  Some- 
times a  wound  will  not  produce  tetanus  till  another 
cause  of  the  disease  takes  place — sudden  cold — and  then 
the  affection  makes  its  appearance.  As  examples  of  the 
kind  of  wounds  which  have  given  rise  to  tetanus,  may 
be  mentioned  those  produced  by  needles  in  the  fingers, 
a  splinter  under  the  nail,  the  extraction  of  a  tooth,  or 
running  nails  in  the  feet.  This  is  one  of  the  most  com- 
mon causes ;  I  saw  two  cases  in  this  city  last  season 
from  this  cause,  neither  of  which  recovered.  Contused 
or  lacerated  wounds  are  liable  to  produce  it,  and  I  think 
the  former  much  worse  in  this  respect  than  incised 
wounds.  The  majority  of  medical  authority  contend 
that  the  attack  is  apt  to  come  on  between  the  fourth 
and  fourteenth  day  after  receiving  the  injury. 

Traumatic  tetanus  is  frequently  favored  by  sudden 
refrigeration,  and  other  causes  of  irritation;  the  two 
causes  combining  may  originate  the  disease,  either  of 
which  separately  would  have  been  insufficient. 

Diagnosis. — It  is  so  striking  in  its  symptoms,  that  you 
can  hardly  confound  it  with  any  other  disease.  You 


CRAMP. 


451 


have  one  very  remarkable  symptom — you  will,  in  90 
cases  out  of  one  hundred,  find  the  tongue  bitten. 
Another  very  characteristic  symptom  is  the  violent  and 
excruciating  pain  at  the  scrobiculus  cordis,  (the  depres- 
sion at  the  pit  of  the  stomach ;)  it  is  not  increased  by 
pressure,  but  it  is  violent,  sharp  and  stabbing.  It  is  some- 
times confounded  with  certain  diseases,  as  with  spinal 
meningitis,  epilepsy,  rheumatism  and  hysteria.  They 
can  easily  be  distinguished  by  a  careful  view  of  the  cir- 
cumstances attending  each  affection. 

Prognosis. — This  is  most  generally  unfavorable ;  it  is 
an  exceedingly  fatal  disease;  traumatic  tetanus,  (this 
arises  from  a  wound,)  is  seldom  recovered  from ;  and  it  is 
said  to  be  equally  as  fatal  where  it  originates  from  intes- 
tinal worms ;  every  variety,  however,  admits  of  recovery. 

Dr.  Parry  says,  on  the  subject  of  prognosis,  that  if  the 
pulse  be  not  above  100  or  110  up  to  the  fourth  or  fifth 
day,  patients  almost  always  recover ;  but  if  the  pulse  be 
quicker  early,  the  disease  almost  always  proves  fatal ; 
and  that  there  have  been  but  very  few  recoveries  when 
the  pulse  has  been  100  the  first  day. 

Treatment — If  you  are  called  to  a  case  of  tetanus 
traumatic,  (which  variety  is  the  result  of  a  wound,) 
your  first  object  must  be  to  remove  any  source  of  irrita- 
tion, and  to  palliate,  as  far  as  possible,  the  most  promi- 
nent symptoms ;  consequently,  to  control  the  spasms,  I 
generally  use  the  compound  tincture  of  lobelia,  as 
advised  by  a  very  distinguished  physician.  The  follow- 
ing is  the  recipe  : 

fy.    Tinct  of  capsicum,  (Cayenne  pepper,) 
 myrrh, 

 cypripedium  pubescens,  (lady  slipper.) 


452 


CRAMP. 


He  advises  the  etlierial  tincture,  one  pint  of  each. 
Lobelia  seeds,  pulverized,  Biv. 

Mix,  and  shake  well  before  using ;  it  is  improved  in 
its  antispasmodic  qualities  by  the  addition  of  tincture  of 
assafcetida.  You  can  give  it  in  doses  of  from  one  to  two 
ounces ;  try  and  get  it  into  his  mouth,  it  will  soon  pro- 
duce relaxation  sufficient  to  enable  him  to  swallow  ;  you 
should  administer  the  same  article  as  an  injection,  it 
will  soon  produce  relaxation,  accompanied  with  nausea 
and  vomiting. 

You  should  keep  up  the  nausea  and  relaxation  by  the 
same  article  or  ipecac,  and  opium,  in  combination  with 
skunk  cabbage;  apply  my  liniment  (as  recommended 
for  rheumatism  and  other  diseases)  along  the  spine; 
after  using  the  liniment  immediately  apply  mustard 
plasters  to  the  whole  course  of  the  spine. 

Some  advise  the  use  of  caustic  potash  to  be  applied  to 
the  wound  for  the  purpose  of  exciting  free  suppuration ; 
whether  this  has  ever  been  of  advantage  is  doubtful,  it 
is  not  in  accordance  with  a  rational  view  of  the  pathology 
of  the  disease.  I  think  a  hop  poultice,  with  an  active 
narcotic,  such  as  morphine,  would  be  decidedly  prefer- 
able to  the  wound,  it  would  have  a  greater  tendency  to 
diminish  irritation;  it  is  but  justice  to  say,  that  some 
contend  from  practical  experience  for  the  potash  to  the 
wound. 

If  you  were  to  consult  the  different  authorities  and 
see  the  versatility  of  opinion  in  regard  to  the  treatment 
of  this  disease,  you  would  find  great  difficulty  in  arriving 
at  any  satisfactory  conclusion ;  almost  every  variety  of 
remedy  has  been  used,  and  cases  are  reported  having 
been  cured  upon  directly  opposite  plans  of  management. 


CRAMP. 


453 


The  medical  journals  teem  with  cases  which  have  been 
cured  under  various  kinds  of  treatment ;  many  allow- 
ances must  be  made  in  regard  to  these  statements,  they 
at  least  give  sufficient  surety  to  encourage  the  practi- 
tioner to  persevere  in  the  use  and  employment  of  means 
which  he  may  consider  as  indicated. 

Most  physicians  agree  as  to  the  propriety  of  purging 
in  this  disease,  almost  any  active  cathartic  which  will 
not  produce  irritation  of  the  mucous  membrane  of  the 
bowels  will  answer,  senna  or  castor  oil,  if  there  is  diffi- 
culty of  swallowing  you  might  give  croton  oil. 

To  diminish  the  susceptibility  of  the  nervous  system 
to  these  attacks,  I  think  opium  has  been  used  with 
decidedly  the  most  advantage ;  some  advise  brandy  or 
wine  for  this  purpose,  the  latter  I  should  not  advise 
unless  there  was  great  prostration  and  evident  debility 
of  the  circulation. 

Dr.  Morrison,  of  the  West  Indies,  Dr.  Latham,  of 
England,  Dr.  McGregor,  of  Edinburgh,  and  most  of  the 
College  of  Physicians  of  Philadelphia,  advise  opium. 
Dr.  Ringer,  of  Demarara,  reports  in  a  pamphlet  his 
success  with  opium. 

Dr.  Martin,  in  the  L'Union  Medicale,  relies  strongly 
on  the  cyanuret  of  potassium,  which  paves  the  way  for 
the  use  of  chloroform  ;  this  latter  is  a  valuable  remedy, 
I  have  no  doubt,  in  controlling  the  spasm.  There  is  an 
article  in  the  September  number  of  the  New  Orleans 
Medical  Journal  of  1852,  in  which  a  physician  of  Mis- 
sissippi reports  four  successful  cases,  treated  by  morphine, 
quinine  and  brandy,  in  large  doses ;  I  have  not  the 
report  by  me,  but  I  recollect  distinctly  the  laconic 
answer  of  that  scientific  and  practical  editor.  Dr.  Hester, 
"mayhap  the  cases  recovered  in  spite  of  the  doctor's 


454 


CRAMP. 


heroic  doses."  But,  Doctor,  this  is  nothing  to  compare 
with  some  of  the  first  English  authority,  and  being 
foreign,  much  weight  is  generally  attached  to  it ;  cases 
are  reported  where  gallons  of  wine  have  been  used  daily, 
and  even  Professor  Elliottson  reports  giving  two  pounds 
of  the  sesquioxide  of  iron  in  a  day,  and  remarkable  to 
say  the  patient  recovered. 

M.  Bailly  and  Bondin,  and  most  of  the  French  mili- 
tary surgeons,  rely,  to  a  great  extent,  on  opium. 

A  very  able  article  upon  this  subject  has  been  written 
by  Mr.  Colles,  of  the  K.  C.  S.,  who  says  in  his  lectures, 
that  there  was  no  application  for  wounds,  in  which  he 
placed  so  much  confidence  as  spirits  of  turpentine,  when 
tetanus  was  to  be  apprehended,  and  it  is  also  highly  ex- 
tolled by  Dr.  O'Reilly,  of  Ireland.  They  give  calomel 
and  opium — the  former  to  prevent  or  arrest  morbific 
action,  the  latter  to  tranquillize  the  system. 

A  very  distinguished  author  says,  that  the  most  effec- 
tual plan  of  treatment  was  put  into  practice  by  Dr. 
Hartshorn,  of  Philadelphia.  It  consists  in  applying 
along  the  spine,  from  the  occiput  to  the  sacrum,  a  solu- 
tion of  caustic  potash,  containing  two  drachms  of  the 
alkali  to  four  ounces  of  water.  This  is  rubbed  up  and 
down  the  spine  by  means  of  a  sponge,  until  the  surface 
is  much  reddened,  and  signs  of  a  caustic  action  are  dis- 
played, in  some  one  point,  by  the  discoloration  of  the 
skin.  The  remedy  may  be  repeated  when  the  inflam- 
mation disappears.  It  has  been  used  with  much  suc- 
cess in  a  number  of  cases.  Dr.  H.  relies  upon  the 
measure,  with  opium  and  purging. 

Dr.  O'Shauglmessy  recommends  hemp  in  this  disease; 
it  has  been  reputed  in  the  journals  to  have  cured  cases. 

A  positive  mode  of  treatment  is  not  settled ;  recovery 


LOCK- J  ATT  OF  INFANTS. 


455 


has  taken  place  under  all  modes  of  treatment ;  yet  I  am 
satisfied,  from  a  number  of  cases  I  have*  treated,  that 
you  will  succeed,  if  you  follow  it,  in  a  fair  proportion  of 
cases. 

See  anti-spasmodic  tincture — last  paragraph  under  the 
head  of  infantile  convulsions. 

TRISMUS  NASCENTIUM. 

Lock-Jaw  of  Infants. — This  is  an  exceedingly  fatal 
variety  of  tetanus,  and  merits  a  distinct  notice.  It 
occurs  in  infants  soon  after  birth,  and  has  received  the 
name  of  trismus  nascentium.  In'  some  portions  of  our 
country,  especially  the  Brazos,  it  is  very  destructive 
among  the  negro  children ;  over  one-half  of  the  colored 
infants  in  that  district  perish  of  the  disease. 

Much  has  been  written  upon  this  subject,  and  in  the 
American  Journal  of  Medical  Science,  for  1848,  there  is 
a  very  able  article  from  the  pen  of  J.  M.  Sims,  M.  D., 
of  Alabama.  It  is  usually  ascribed  to  irritation  arising 
from  the  cutting  of  the  cord,  and  dissection  has  gene- 
rally revealed  ulceration  of  the  umbilicus,  with  more  or 
less  inflammation  of  the  investments  of  the  umbilical  ves- 
sels, and  of  the  peritoneal  membrane.  The  attack  gene- 
rally comes  on  in  either  the  first  or  second  week  from 
birth ;  it  is  always  attended  with  contractions  or  spasmo- 
dic closure  of  the  jaws,  and  frequently  other  muscles  are 
affected.  Many  Southern  practitioners,  who  have  seen 
a  great  deal  of  it,  declare  that  they  have  never  known 
an  instance  of  recovery. 

I  have  seen  many  cases  of  this  disease,  and,  in  con- 
nection with  the  causes  heretofore  assigned,  recollect 
one  fact — this  disease  seldom  if  ever  attacks  white  chil- 
dren ;  in  every  case  that  I  have  seen,  I  have  found  the 


456 


LOCK-JAW  OF  INFANTS. 


occipital  bone,  (the  bone  at  the  base  of  the  skull,) 
pressed  either  entirely  or  nearly  so,  under  the  parietal 
Loncs,  to  such  an  extent  as  to  form  a  ridge  sufficiently 
prominent  to  be  felt,  around  the  superior  and  lateral 
portion  of  the  occiput.  You  will  find,  when  called  to  a 
case  of  this  character,  that  the  least  pressure  on  the 
occiput  increases  the  irritation  and  pain,  and  relief  is 
immediately  afforded,  by  pressing  upon  the  parietal 
bones.  May  not  this  be  accounted  for  from  the  fact, 
that  negro  children  are  suffered  to  lie  constantly;  never 
handled,  unless  it  be  to  put  them  to  the  breast,  and  fre- 
quently that  does  not  change  the  position  of  the  child, 
for  the  occiput  generally  rests  on  the  arm  of  the  mother. 
On  examination,  you  will  find  the  occipital  bone  de- 
pressed, and  a  ridge  more  or  less  prominent  will  be  felt, 
by  examining  the  suture  with  your  fingers  it  is  easily 
discernible,  when  it  may  not  be  so  to  the  eye. 

I  have  relieved  case  after  case  by  gentle  manipulation 
of  the  head.  I  generally  place  the  child  upon  its  side, 
put  my  hand  under  the  side  of  its  head,  place  the  other 
on  the  opposite  side,  and  make  gentle  pressure  upon  the 
front  part  of  the  parietal  bones ;  this  expands  them  when 
they  are  in  contact  with  the  occipital  bone,  and  leaves 
this  bone  free  to  assume  its  proper  place.  Gentle  man- 
pulation  will  soon  control  the  difficulty,  and  great  care 
should  be  taken  that  the  child  should  never  be  placed 
upon  its  back. 

I  have  no  doubt  but  the  disease  is  frequently  pro- 
duced from  the  irritation  of  the  umbilicus,  and  I  gene- 
rally apply  caustic  potash,  and  establish  an  issue  at  the 
umbilicus ;  move  the  bowels  gently  with  castor  oil. 

This  has  been  styled  an  incurable  disease.  My  direc- 
tions are  short,  plain,  and  simple,  and,  if  followed,  you 


DELIRIUM  TREMENS. 


457 


will  meet  with  success  frequently,  where  there  is  but 
little  hope  to  expect  it. 

MANIA-A-POTU. 

Mania-a-potu. — This  is  a  disease  which,  unfortunately, 
occurs  frequently  amongst  us.  It  is  a  state  of  delirium 
with  more  or  less  agitation  and  tremor;  generally,  in 
fact  always,  follows  the  suspension  of  ardent  spirits  or 
other  stimulants  producing  morbid  irritability  rather 
than  inflammation ;  it  approximates  very  closely  to  that 
state  which  frequently  takes  place  after  active  inflam- 
mation of  the  brain. 

Causes. — Drs.  Coates,  Sutton,  and  Chapman,  have 
written  ably  upon  it ;  the  former  contends  that  the 
disease  is  the  result,  not  of  the  application  of  spirits^and 
narcotics,  but  of  the  sudden  intermission  of  the  use  of 
these  articles.  It  is  said  to  have  followed  an  acute 
rheumatism,  scarlet  fever,  and  I  have  seen  instances 
where  it  followed  after  typhus  fever. 

Symptoms. — The  disease  is  evidently  one  of  irritation ; 
it  has  no  symptom  in  common  generally  with  inflamma- 
tion. The  most  prominent  symptom  is  a  clammy  perspi- 
ration, face  generally  pale,  muscular  tremors,  imagines 
that  he  sees  a  great  many  things  that  are  calculated  to 
injure  him,  and  with  no  disposition  whatever  to  sleep. 

Pulse. — It  is  soft  and  quick,  at  length  becomes  flutter- 
ing ;  he  is  constantly  talking  delirious ;  with  difficulty 
you  can  keep  him  in  bed.  The  disease  exists  in  various 
degrees  of  intensity,  and  with  different  complications. 
There  is,  as  we  before  remarked,  a  constant  watchful- 
ness ;  he  fancies  a  thousand  imagined  wrongs ;  he  has 
frightful  imaginations,  vague  alarms,  accompanied  with 
weakness  and  depression ;  there  is  loss  of  appetite,  and 


458 


DELIRIUM  TREMENS. 


tremor  of  the  whole  body.  As  the  disease  advances,  he 
imagines  he  sees  a  variety  of  disgusting  objects ;  gene- 
rally imagines  he  sees  insects  or  serpents  about  his  bed 
or  on  the  wall ;  his  hallucinations  are  very  diversified. 
The  patient  generally  evinces  no  malice  in  this  disease ; 
very  seldom  attempts  to  injure  those  around  him. 

It  is  generally  attended  with  more  or  less  febrile  symp- 
toms. 

Treatment. — Your  first  object  will  be  to  allay  the 
paroxj^sm,  and  to  calm  and  give  support  to  the  nervous 
system.  The  indications  of  treatment  are  clearly  to 
stimulate  the  brain  up  to  the  point  essential  to  its  cor- 
rect action,  and  after  you  have  reinstated  in  its  normal 
(healthy)  functions,  then  to  gradually  withdraw  the 
stimulant. 

To  fulfil  the  first  indication,  you  may  give  brandy  or 
spirits,  such  as  he  has  been  in  the  habit  of  drinking. 
If  it  does  not  afford  relief,  I  generally  bathe  the  feet  and 
legs  in  warm  water,  and  apply  mustard  plasters  to  the 
extremities,  and  give  a  stimulating  emetic.  You  should 
persevere  in  the  use  of  this  latter  remedy  until  free 
vomiting  is  produced.  The  following  is  well  adapted 
for  this  purpose  : — 

^.    Tinct.  of  capsicum. 
 of  myrrh. 

 cypripedium  pubescens  (lady  slipper,) 

aa.  1  pint. 

Lobelia  seeds  pulv.  Siv. 
Mix,  and  shake  thoroughly  before  using. 
Give  it  in  half  drachm  doses  in  some  warm  infusion, 
repeated  at  short  intervals  until  vomiting  is  produced. 

After  the  vomiting,  the  remedy  for  the  disease  is 
opium,  and  in  full  and  repeated  doses.    I  generally  com- 


DELIRIUM  TREMENS. 


459 


bine  it  with  morphine ;  give  one  grain  of  each  every  two 
hours.  In  violent  cases  I  increase  the  close,  and  con- 
tinue its  use  until  a  decided  narcotic  impression  is 
made.  You  should  persevere  in  the  remedy  until  you 
produce  sleep,  when  it  should  be  gradually  omitted  or 
diminished.  This  should  be  combined  with  a  very 
nourishing  diet,  such  as  beef  tea,  &c. 

If  the  pulse  be  very  feeble,  and  the  patient  much 
prostrated,  you  may  allow  him  ale,  or  a  small  quantity 
of  spirits.  You  will  find  hop  tea  In  these  cases  to 
answer  a  most  admirable  purpose. 

Where  the  tremors  are  very  excessive,  and  there 
seems  to  be  a  tendency  to  convulsions,  I  would  advise 
the  nervous  stimulants  in  connection  with  the  other 
remedies.  Some  advise  the  compound  spirit  of  sulphu- 
ric ether.  I  have  used  assafoetida  with  decided  advan- 
tage. 

Wherever  there  is  excessive  prostration,  sulphuric 
ether,  administered  from  a  drachm  to  half  ounce  at 
short  intervals,  will  frequently,  if  combined  with  good 
brandy,  sustain  the  patient. 

The  bowels  should  be  kept  free,  in  a  soluble  condi- 
tion. If  the  hepatic  secretion  (secretion  from  the  liver) 
is  deficient,  you  should  administer  small  doses  of  poclo- 
phyllin  (mandrake)  or  leptanclrin.  To  keep  the  bowels 
regular,  magnesia  and  rhubarb  will  answer  well. 

There  are  cases  of  this  description  where  the  patient 
labors  under  great  irritability  of  stomach.  If  a  mustard 
plaster  over  the  stomach  fails  to  allay  this  irritation,  I 
then  give  lime  water  and  milk,  or  a  Seidlitz  powder. 

If  a  typhus  condition  should  supervene,  which  very 
rarely  happens,  he  must  be  supported  by  carbonate  of 
ammonia,  brandy,  musk,  and  beef  tea. 


460 


PALSY. 


The  tincture  of  hops  is  valuable  in  delirium  tremens 
and  watchfulness,  in  connection  with  nervous  irrita- 
tion, anxiety,  or  exhaustion.  Dose — one  to  lour  fluid 
drachms. 

The  above  is  a  course  of  treatment  which  my  expe- 
rience fully  justifies  in  recommending  to  you.  Others 
have  proposed  different  plans,  founded  on  the  opinion 
that  the  disease  was  inflammatory,  and  have  advised 
from  this  fact  the  lancet.  This  I  conceive  to  be  the 
most  dangerous  treatment,  yet  still  it  might  be  necessary 
in  complicated  cases.  If  you  use  the  lancet,  it  should 
be  with  extreme  caution. 

The  skullcap  is  highly  extolled  in  this  disease.    It  is 
said  that  an  infusion  drank  freely  will  soon  produce  a 1 
calm  sleep. 

PARALYSIS. 

The  next  disease  to  which  I  shall  call  your  attention, 
and  which  should  have  properly  followed  apoplexy,  is 
paralysis  or  palsy. 

It  is  a  disease  principally  affecting  the  nervous  sys- 
tem, and  you  may  define  it  to  a  loss  or  diminution  of 
sense,  or  of  motion,  or  of  both,  independent  of  inflamma- 
tion or  mechanical  impediment;  but  dependent  entirely 
upon  the  condition  of  its  nerves,  or  some  other  part  of 
the  nervous  system. 

Varieties. — It  is  usually  divided  into  three  varieties  : 
hemiplegia,  affecting  one  half  of  the  body,  divided  verti- 
cally ;  paraplegia,  affecting  one  half  of  the  body,  divided 
horizontally;  and  paralysis  partialis,  affecting  only  one 
particular  limb,  or  one  particular  sense.  There  are  no 
other  varieties  of  minor  consideration,  unless,  however, 
it  is  amaurosis,  partial  paralysis  of  the  eye. 


PALSY. 


4G1 


Causes. — As  we  before  remarked,  this  article  should 
have  followed  apoplexy,  as  this  disease  frequently  arises 
in  consequence  of  it.  Anything  that  has  a  tendency  to 
produce  pressure  "upon  any  part  of  the  nervous  system 
may  produce  it ;  and  likewise,  it  may  be  produced  by 
anything  that  prevents  the  flow  of  the  nervous  power 
from  the  brain  into  the  organs  of  motion ;  hence  effused 
fluids,  tumors,  over-distention,  &c,  frequently  give  rise 
to  it.  A  suppression  of  usual  evacuations,  a  translation 
of  morbid  secretion  to  the  head,  and  pressure  on  the 
nerves  by  wounds  or  fractures  will  occasion  it.  Others 
contend  that  the  long  continued  application  of  sedatives 
will  generally  produce  palsy,  as  we  find  those  whose 
occupations  subject  them  to  the  constant  handling  of 
white  lead,  and  •  those  who  are  much  exj)osed  to  the 
poisonous  fumes  of  metals  or  minerals,  are  liable  to  be 
attacked  with  it.  If  a  part  become  exceedingly  benumbed 
from  cold,  it  will  produce  what  I  term  common  paral- 
ysis, for  a  longer  or  shorter  period.  In  general,  what- 
ever interferes  with  the  structure  of  the  nervous  centres, 
the  nervous  filaments  or  ramifications,  or  its  functions  at 
the  periphery,  (circumference^)  or  at  the  centre,  may, 
and  most  probably  will,  become  a  remote  cause  of  paral- 
ytic symptoms. 

Symptoms. — It  is  said  by  most  authors  to  come  on 
with  a  sudden  and  immediate  loss  of  motion  and  sensi- 
bility of  the  parts ;  but  in  some  instances  it  is  preceded 
by  a  numbness,  coldness  and  paleness,  and  sometimes 
by  slight  convulsive  twitches.  "When  the  head  is  much 
effected  the  eye  and  mouth  are  drawn  to  one  side,  the 
memory  and  judgment  much  impaired,  and  the  speech 
is  indistinct  and  incoherent.  If  the  disease  affects  the 
extremities,  and  has  been  of  long  duration,  it  not  only 


462 


PALSY. 


produces  a  loss  of  motion  and  sensibility,  but  likewise  a 
considerable  nacidity  and  wasting  away  in  the  muscles 
of  the  parts  affected. 

The  most  perfect  form  of  cerebral  palsy  is  hemiplegia, 
in  which  the  affection  extends  over  the  whole  of  one 
side  of  the  body,  from  the  head  to  the  foot.  Sometimes 
it  takes  the  form  of  paraplegia,  or  palsy  of  the  lower 
extremities  \  and  in  some  rare  instances  the  affection  is 
confined  to  the  loss  of  functions  in  a  particular  nerve. 

Hemiplegia,  to  which  form  of  the  disease  the  term 
palsy  is  in  common  language  appropriated,  has  generally 
been  considered  as  a  minor  degree  of  apoplexy.  The 
attack  is  sometimes  unexpected,  but  more  commonly  it 
is  preceded  for  several  days,  or  even  weeks,  by  one  or 
more  of  those  symptoms  formerly  described  as  the  fore- 
runners of  apoplexy;  such  as  giddiness,  drowsiness, 
numbness,  dimness  of  sight,  failure  of  the  powers  of  the 
mind,  forgetfulness,  transient  delirium,  or  indistinctness 
of  articulation.  For  the  most  part  the  paralytic  seizure 
is  sudden ;  but  occasionally  the  approaches  of  the  disease 
are  made  more  slowly,  a  finger,  a  hand  or  an  arm,  the 
muscles  of  the  tongue,  of  the  mouth,  or  of  the  eyelids 
being  first  affected,  and  the  paralytic  state  gradually 
extending  to  distant  parts. 

This  variety  is  not  generally  perfect  paralysis,  from 
the  fact  that  the  eye,  the  ear,  nose  and  tongue  of  the 
affected  side,  have  their  senses  actively  enough.  It  may 
be  a  mere  hysterical  affection,  and  soon  recovered  from. 

Sir  G.  Blune  says,  from  some  comparative  observa- 
tions made  by  him  when  physician  of  St.  Thomas'  Hos- 
pital, that  he  found  three  cases  of  hemiplegia  on  the 
left  side,  for  two  on  the  right.  The  pulse  on  the 
paralytic  side  is  smaller  than  on  the  other. 


PALSY. 


4G3 


A  very  distinguished  author  says,  an  attack  of  this 
description  more  frequently  occurs  in  bed,  than  in  any 
other  place.  Many  persons  who  lose  the  use  of  one 
side  suddenly,  and  who  have  no  decided  apoplectic 
attack,  say  that  it  happened  in  bed ;  or  that  it  occurred 
late  at  night,  or  very  early  in  the  morning. 

The  general  effects  are  various,  where  the  muscles  are 
deprived  of  the  influence  of  the  will,  the  face  is  drawn 
to  the  opposite  or  healthy  side,  from  the  fact  that  the 
opposite  side  is  in  a  healthy  connexion  with  the  brain, 
and  the  muscles  of  that  side  master  the  others  com- 
pletely. The  patient  generally,  has  not  the  power  to 
spit ;  his  saliva  runs  from  the  corner  of  his  mouth ;  if 
his  mouth  is  affected,  his  voice  becomes  altered,  and  he 
seldom  articulates  with  distinctness  enough  to  be  under- 
stood. 

If  the  disease  has  continued  for  any  length  of  time, 
the  mind  suffers  a  little,  especially  in  attention  and 
memory;  the  limbs  waste,  diminish  in  size,  and  become 
very  flabby. 

There  are  a  variety  of  cases  published,  where  this 
disease  has  had  a  tendency  to  affect  the  intellectual 
powers,  there  is  generally  a  want  of  memory  in  most  of 
the  cases  reported. 

Diagnosis. — There  can  be  but  little  difficulty  in  re- 
cognizing this  disease.  There  may  be  occasionally  some 
difficulty  in  deciding,  whether  a  part  deprived  of  the 
power  of  motion,  is  laboring  under  palsy,  or  under 
inflammatory  disease  of  a  rheumatic  or  gouty  character. 
They  are  evidently  sometimes  mingled ;  you  sometimes 
find  rheumatism  in  the  course  of  a  nerve,  which  may 
partially  paralyze  the  nerves  of  the  part  in  which  it 


404 


PALSY. 


exists.  But,  in  such  cases,  the  previous  history  will 
soon  decide  the  point. 

Paraplegia. — Palsy  which  affects  one-half  of  the  body, 
horizontally  divided. — Symptoms. — In  this  variety,  it  is 
frequently  accompanied  with  constipation  and  retention 
of  urine,  and  again  the  muscles  of  the  anus  become  so 
much  paralysed,  that  the  faeces  and  urine  pass  involun- 
tarily. These  symptoms  you  seldom  find  in  hemiplegia. 
It  is  said,  that  in  this  disease,  the  urine  is  altered  in 
quality;  it  is  asserted  that  it  is  not  sufficiently  acid,  or 
it  is,  perhaps,  alkalescent,  (becomes  alkaline ;)  but  when 
it  is  not,  there  is  still  a  deficiency  of  acid.  ,  This  is  more 
particularly  the  case,  where  the  paralysis  has  arisen 
from  an  injury  of  the  spine. 

It  generally  comes  on  gradually,  commencing  at  the 
toes,  gradually  extending  upwards,  until  it  gets  above 
the  hips. 

That  variety  of  diseases  occurring  in  the  brain,  which 
I  have  asserted  will  produce  hemiphlegia,  "if  the  spinal 
marrow  is  the  least  involved,  will  produce  paraplegia ; 
it  is  frequently  produced  by  fracture  of  the  vertebrae,  or 
caries  (decay)  of  the  same;  cases  are  reported,  where  it 
occurred  from  persons  working  in  cold  water. 

Treatment. — If  there  be  a  local  cause,  your  first  object 
must  be  to  ascertain  the  condition  on  which  the  affection 
depends,  and  attempt  its  removal,  if  possible ;  if  it  should 
result  from  a  fracture  of  the  cranial  bones,  it  will  re- 
quire surgical  assistance,  which  should  be  immediately 
adopted,  for  removing  any  source  of  irritation.  It  is  a 
primary  consideration  to  direct  your  attention  to  the 
cause  producing  the  disease,  and  promptly  to  correct  the 
evil,  if  possible,  whatever  that  may  be. 


PALSY. 


465 


In  cases  that  come  on  suddenly  and  violently  we 
advise  you  in  general  to  pursue  the  course  as  advised  in 
apoplexy.     If  it  results  from  active  congestion  or  in- 
flammation you  should  adopt  an  antiphlogistic  course 
(remedies  that  oppose  inflammation,)  in  proportion  to 
the  energies  of  his  system.    In  this  variety  purgatives 
would  be  very  useful,  and  they  rarely  fail  of  proving 
beneficial  to  the  patient ;  you  should  adopt  also  local 
depletion  by  cupping  or  blistering,  with  a  low  diet ;  but 
you  must  be  constantly  on  your  guard  not  to  push  this 
treatment  too  far ;  as  a  purgative  I  give  podophyllin 
and  leptandrin  in  small  doses,  sufficient  to  keep  the 
bowels  well  open. 

In  chronic  cases,  the  paralysis  remains  long  after  the 
irritation  or  inflammation  has  subsided,  and  in  this 
character  of  cases  an  almost  constant  application  of  a 
blister  as  near  to  the  seat  of  the  disease  as  possible,  with 
moderate  purgation,  will  be  of  benefit,  but  great  care 
must  be  taken  not  to  bring  him  too  low  with  your 
chronic  treatment,  he  must  abstain  from  spirits  and 
animal  food  if  possible,  but  of  this  you  must  judge,  his 
strength  must  be  supported;  occasionally  tonics  are 
indicated,  and  if  there  be  great  debility,  you  need  not 
fear  giving  him  wine.    Your  blisters,  as  I  before  said, 
should  be  applied  near  the  part  affected,  for  instance,  if 
hemiplegia,  your  counter  irritatant  should  be  upon  the 
nape  of  the  neck,  especially  if  the  head  is  affected,  and 
on  the  spine  in  paraplegia ;  the  following  poultices  or 
plasters  are  also  sometimes  beneficially  applied  in  both 
instances :    Take  equal  parts  of  cayenne  pepper,  mus- 
tard and  meal,  moistened  with  vinegar,  and  apply  to 
the  feet,  between  the  shoulders,  and  on  the  parts  affected. 
You  may  substitute  moxa  (a  mode  of  cauterization, 
30 


466 


PALSY. 


you  take  cotton,  form  it  into  a  cone,  place  it  upon  the 
affected  part  and  set  it  on  fire  at  the  top,)  if  circum- 
stances seem  to  indicate  it.  • 

If  you  have  removed  the  original  cause,  or  have  good 
reason  to  think  so,  even  when  such  is  the  fact,  the  palsy 
remains  in  many  cases  from  debility ;  in  such  cases  "  it 
will  be  advisable  to  make  use  of  measures  calculated  to 
excite  the  nervous  action.    It  is  a  very  common  error 
to  resort  to  these  measures  early  in  the  disease,  and 
while  the  organic  cause  is  still  in  operation.  Nothing 
could  be  worse  than  such  a  proceeding."    After  every 
symptom  of  inflammation  or  irritation  has  subsided  then 
stimulating  remedies  are  indicated ;  of  this  class  strych- 
nine is  particularly  recommended ;  some  use  the  other 
alkaline  principle  of  nux  vomica,  the  brucia ;  although 
it,  (strychnine,)  is  a  narcotic  and  will  destroy  life,  it  is 
nevertheless  a  powerful  stimulant  to  the  nervous  sj7stem ; 
when  either  of  these  remedies  are  properly  timed  they 
are  undoubtedly  beneficial ;  all  evidences  of  excitement 
should   have   subsided   before  they  are  resorted  to. 
"  When  employed  it  should  be  with  great  caution,  and  if 
the  complaint  is  in  any  degree  aggravated"  they  should  be 
discontinued  at  once.   "  The  best  preparations,  upon  the 
whole,  are  probably  the  alcoholic  extract  and  strychnine. 
Of  the  latter  not  more  than  one-twelfth  of  a  grain  should 
be  given  at  first,"  and  not  repeated  oftener  than  twice 
or  three  times  a-day;  the  dose  may  be  gradually  in- 
creased until  slight  involuntary  twitchings  of  the  muscles 
take  place.    Other  stimulants  have  occasionally  been 
used  with  advantage,  turpentine  and  cantharides,  these 
are  frequently  used,  and  in  connection  with  stimulating 
injections ;  the  following  is  frequently  used  with  much 
benefit  when  there  is  a  torpid  paralytic  condition  of  the 


PALSY. 


467 


bowels  :  Take  cayenne  pepper,  one  tea-spoonful,  lobelia, 
two  tea-spoonsful,  add  a  pint  of  boiling  water ;  after  it 
has  drawn  some  time  add  molasses,  half  a  pint  of  milk 
and  a  gill  of  sweet  oil,  let  it  be  injected  warm,  one-half 
at  a  time,  it  will  generally  excite  sufficient  action  to 
promote  an  evacuation.  Salt  and  water  is  also  very 
good. 

Friction  is  very  necessary  in  this  complaint ;  if  the 
feet  or  legs  swell,  they  should  be  steamed  over  bitter 
herbs ;  if  it  should  be  confined  to  either  of  the  limbs, 
the  irritating  plaster  which  has  heretofore  been  advised 
will  be  found  beneficial. 

If  the  patient  does  not  improve  under  the  above  treat- 
ment, I  would  give  the  following  alterative  syrup : 

fy.    Stillingia,  (queen's  root,)     1  pound. 
Corydallis,  (stagger  weed,)  \  " 
Ampelopsis,  (woodbine,)     I  " 
Iris,  versic.  (blue  flag,)        i  " 
Mix,  and  make  five  quarts  of  syrup.    Give  one  tea- 
spoonful  three  or  four  times  a  day.    Some  add  hydrio- 
date  of  potassa,  5iss.,  to  the  above.   Whilst  your  patient 
is  taking  this,  let  him  rub  well  the  affected  part  with 
my  liniment. 

"The  douche  of  hot  water,  and  when  there  is  suffi- 
cient energy  for  prompt  reaction,  of  cold  water,  will 
sometimes  be  found  useful."  Electricity  is  a  valuable 
local  remedy,  and  acupuncture  has  been  recommended, 
which  is  to  introduce  needles  into  the  flesh  at  some  dis- 
tance apart,  and  by  being  connected  with  the  opposite 
galvanic  poles,  enable  a  current  of  the  fluid  to  be  car- 
ried through  the  palsied  muscle  itself;  if  it  should  prove 
the  least  injurious,  it  should  be  discontinued. 


468 


PALSY. 


Opium  is  very  proper  to  lessen  the  twitches  and  vio- 
lent pain,  I  have  used,  also,  the  tincture  of  hops  and 
extract  of  hyosciamus,  (henbane)  with  advantage. 

The  following  prescriptions  have  all  been  highly 
extolled  in  paralysis : 

fy.    Flowers  of  arnica,  Si. 

Water,  3  pints. 

Boil  till  reduced  to  two  pints,  strain  and  add  syrup  of 
ginger,  gii.  Dose,  one  to  two  ounces  every  two  or  three 
hours. 

Dr.  Thompson  advises  the  following  : 

R.    Assafoetidse,  5iss. 
Powdered  ginger,  3ss. 
Syrup,  q.  s. 

Make  into  thirty  pills.    Give  three  every  four  hours. 

The  following  is  the  recipe  alluded  to  in  our  treat- 
ment : 

3$5.    Brucia,  grs.  vi. 

Distilled  water,  Biv. 

Sugar,  3ii. 
Mix.    A  table-spoonful  morning  and  evening,  gradu- 
ally increasing  the  dose. 

Another — 


jfy.    Ext.  opium, 
Nitrate  silver, 
Musk, 
Camphor, 
Make  into  ninety-six  pills, 
night. 


grs.  72. 
grs.  vi. 
grs.  48. 
grs.  96. 
Give  one  morning  and 


MILK-LEG. 


469 


A  bath  of  common  salt  and  arnica  is  highly  recom- 
mended. 

Diet. — If  the  paralysis  arises  in  a  person  of  a  full 
habit,  the  diet  should  be  spare ;  if  in  a  debilitated  per- 
son, it  should  be  invigorating,  seasoned  with  spicy  and 
aromatic  vegetables,  such  as  mustard  and  horseradish. 
Exercise  is  of  importance ;  flannel  should  be  worn  next 
to  the  skin,  and  cold,  moist  or  damp  air  avoided. 

PHLEGMASIA  DOLENS. 

White  or  Tumid  Leg. — This  affection  is  vulgarly 
called  milk  leg.  It  occurs  in  females  soon  after  delivery. 
It  is  sometimes  seen  in  unmarried  females,  and  even  in 
males.  It  usually  attacks  one  leg,  and  frequently  the 
whole  system  is  more  or  less  affected.  It  first  makes  its 
appearance  in  the  loins  or  lower  portion  of  the  abdomen, 
gradually  extending  down  to  the  thigh  and  leg ;  in  some 
instances  it  commences  quite  the  reverse,  beginning  in 
the  leg  and  extending  up.  It  is  generally  preceded  by 
a  chill,  succeeded  by  fever.  The  affected  limb  appears 
firm,  glossy,  swollen,  and  very  painful,  and  in  the  course 
of  48  hours,  is  sometimes  of  twice  its  usual  dimensions ; 
the  limb  is  stiff,  heavy,  and  irritated  by  motion ;  there 
is  generally  extreme  tenderness  along  the  femoral  vein, 
which  may  always  be  felt  like  a  hard  cord ;  the  limb  is 
apt  to  remain  stiff  and  weak  for  a  considerable  time. 

Some  contend  that  it  arises  from  a  suppression  of  the 
hchial  discharge,  or  the  milk,  or  from  cold;  others  con- 
tend that  it  is  milk  secreted  in  the  leg,  producing  inflam- 
mation of  the  cellular  tissue,  (which  are  numerous  cells, 
communicating  with  each  other;  they  contain  fatty 
matter,  and  are  principally  situated  at  the  end  of 
bones.)    Some  ascribe  it  to  inflammation  of  the  absorb- 


470 


MILK-LEG. 


ent  vessels,  &c.  These  doctrines-  have  been  taught  by 
Builland,  of  France,  and  Davis,  of  England,  and  by  a 
host  of  American  physicians.  It  might  be  deemed  ego- 
tistical in  me  to  pronounce  the  nature  of  this  disease  as 
taught  by  these  gentlemen  and  others  in  high  places  as 
absurd,  but  the  truth  is,  as  we  have  before  observed,  that 
there  are  many  men  who  will  pretend  to  science  and 
skill  who  really  possess  neither ;  and  I  am  inclined  to 
the  'opinion,  that  you  will  see  these  dogmas  advocated 
only  by  those  who  flatter  themselves  that  they  have 
learned  enough  in  their  profession,  and  who  cease  to 
read  books,  they  tell  you  milk  leg,  as  it  is  vulgarly  and 
ignorantly  called,  is  inflammation  of  the  cellular  tissue. 
I  assert  that  no  man  ever  saw  a  case  in  which  this 
disease  rwas  attended  with  suppuration  or  sloughing ; 
and  I  farther  assert,  that  where  these  tissues  do  become 
inflammed,  they  are  almost  certain  to  terminate  in  that 
manner.  A  very  distinguished  author,  and  one  who  has 
imparted  much  useful  information,  says,  he  should  like 
to  see  a  woman  get  well  of  an  inflammation  of  the  cel- 
lular tissue  of  the  whole  limb,  from  the  pelvis  to  the 
foot,  and  from  the  pules  to  the  great  toe ;  one  whose 
thigh  is  bigger  than  a  man's  body,  and  her  leg  swollen 
to  the  size  of  that  of  an  elephant — that  is  to  say,  get 
well  without  a  suppuration,  or,  indeed,  in  any  way.  He 
says  farther,  that  some  persons  have  supposed  that  the 
swelling  is  produced  by  a  disease  of  the  absorbents  of 
the  limb;  and,  in  fact,  nothing  was  known  about  it 
until  Kobert  Lee  (we  copy  this  paragraph  from  the  fact, 
that  we  think  Dr.  Lee  a  benefactor  to  his  country,) 
made  the  discovery  of  it,  and  clearly  demonstrated  its 
true  pathological  nature ;  showing  that  the  lesion  of  the 
disease  is  a  lesion  of  the  veins  of  the  limb,  for  which  he 


MILK-LEG. 


471 


gave  it  the  name  of  crural  phlebitis,  the  name  by  which 
it  is  called  by  all  physicians  who  know  anything  about 
it ;  it  is  called  milk-leg,  vulgarly,  and  I  think  errone- 
ously. 

It  is  a  disease,  as  we  have  before  shown,  that  attacks 
both  sexes. 

The  veins  in  the  interior  of  the  body  are,  for  a  long 
time,  compressed  by  the  gravid  uterus,  and  sometimes 
compressed  with  great  force,  which  is  increased  enor- 
mously in  the  throes  of  labor.  They  are  not  only  com- 
pressed, so  as  in  some  instances  absolutely  to  suffer  con- 
tusion, but  the  whole  of  the  veins  of  the  lower  extremi- 
ties are,  in  many  women,  for  a  long  time,  distended  by 
the  pressure  of  the  womb,  causing  oedema,  (swelling,) 
and  that  very  common  occurrence,  varix,  (enlargement 
of  a  vein.)  Such  a  constant,  long  continued  pressure 
upon  the  vessels  might  well  be  supposed  to  have,  in 
many  instances,  the  effect  of  developing  an  inflamma- 
tory state  there,  which  would  be  more  likely  to  effect 
the  veins  below  than  above  the  point  of  pressure. 

Affections  have  been  observed  that  are  almost  identi- 
cal with  this  disease,  (if  not  the  same,)  in  women  after 
abortion,  or  where  an  unimpregnated  uterus  had  suffered 
violence.  Men  have  been  affected  in  consequence  of 
organic  disease  in  the  pelvic  viscera.  Dr.  Stokes  calls 
attention  to  occasional  occurrence  of  inflammation  of  the 
lower  extremities,  in  all  essential  points  identical  with 
that  under  consideration,  following  fevers. 

It  will  "  be  first  suspected  by  pain  felt  at  the  groin, 
or  in  the  calf  of  the  leg.  I  am  very-sure  that,  in  many 
of  the  cases  I  have  met  with,  my  first  detection  of  the 
existence  of  the  malady  was  made  in  consequence  of 
complaints  as  to  pain  in  the  calf  of  the  leg."    If  a  lady 


472 


MILK-LEG. 


after  lier  confinement  complains  of  a  pain  in  the  calf  of 
the  leg,  you  may  safely  suspect  that  this  disease  is 
about  making  its  attack.  You  should  put  your  thumb 
upon  the  spine  of  the  tibia,  (vulgarly  called  shin- 
bone)  and  your  fingers  upon  the  calf,  and  then  suddenly 
compress  the  muscles  against  the  bone ;  if  the  woman 
shrinks  from  the  pressure,  and  makes  an  outcry,  I  next 
ask  permission  to  examine  the  groin,  and  if  I  feel  the 
swollen  ridge  and  enlargement  of  the  vessels,  I  know 
that  my  patient  labors  under  phlebitis.  I  then  examine 
the  external  iliac  artery,  by  pressing  the  integuments 
against  the  brim  or  strait  of  the  pelvis,  as  far  as  I  can 
push  them ;  when  you  will  be  very  sure  to  detect  the 
evidence  of  inflammation  extending  up  into  the  body,  if 
it  goes  so  far  inwards. 

The  calf  of  the  leg  will  be  found  hard.  Let  the 
woman  lie  upon  her  back,  and  be  directed  to  draw  both 
of  the  knees  up  in  the  bed,  until  the  tibia  (or  what  is 
vulgarly  termed  shin-bone)  become  nearly  vertical.  You 
now  take  hold  of  the  calf  of  the  leg,  lightly,  from  behind, 
and  endeavor  to  shake  it  from  side  to  side.  You  will 
find  you  cannot  shake  it,  for  the  whole  mass  seems 
attached  to  the  bone,  or  packed  against  it.  If  you  shake 
the  other  calf  it  will  be  perfectly  flabby  and  movable  in 
your  hand ;  the  result  of  this  comparison  will  settle  the 
diagnostic. 

Treatment, — You  should  commence  the  treatment  by 
regulating  the  secretions ;  the  bowels  should  be  kept  in 
a  soluble  condition,  and  you  should  by  all  means  endea- 
vor to  promote  moisture  of  the  skin ;  if  the  ridge  along 
the  femoral  artery  is  hard,  some  benefit  will  result  from 
the  application  of  cups,  scarifying  freely.  The  patient 
must  be  confined  to  her  back;  the  whole  limb  to  be 


MILK-LEG. 


473 


placed  upon  pillows,  so  as  slightly  to  elevate  the  whole 
leg  above  the  body,  and  she  should  be  told  with  sincerity, 
that  if  she  puts  her  foot  upon  the  floor,  even  after  she  is 
almost  well,  that  it  will  almost  certainly  reproduce  the 
disease.  An  author  of  reputation  says,  is  it  not  very 
clear  that  if  she  puts  her  foot  upon  the  floor  and  stands 
upon  it,  she  will  have  to  lift  the  whole  column  of  blood 
in  the  veins,  from  the  sole  of  the  foot  to  the  extremity 
of  the  vena  cava,  at  the  expense  of  the  'most  enormous 
strain  upon  the  sides  of  the  vessel  ?  It  would  be  the 
grossest  malpractice  to  allow  the  woman  even  to  sit  up 
on  a  sofa,  until  the  limb  is  safe. 

You  should  then  take  equal  quantities  of  vinegar  and 
boiling  water ;  take  two  or  three  yards  of  flannel,  or  a 
flannel  shirt  or  petticoat,  immerse  it  in  the  hot  liquor, 
wring  it  out  and  wrap  the  leg  up  in  it ;  this  process 
should  last  about  six  hours.  I  sometimes  substitute  for 
the  former,  hops,  and  steam  the  leg  over  bitter  herbs ;  if 
hot  applications  aggravate  it,  you  can  bathe  it  in  warm 
sweet  oil  and  laudanum,  carefully  applying  the  flannel 
afterwards.  I  sometimes  keep  the  limb  wet  with  stra- 
monium leaves,  (Jamestown)  simmered  in  spirits  and 
applied  cool;  ley  water  is  recommended  hi  obstinate 
cases,  and  the  limb  anointed  with  bitter-sweet,  or  mul- 
lein ointments.  To  prevent  the  moisture  from  soiling 
the  bed  clothes,  a  piece  of  oiled  silk  should  be  spread 
beneath  it.  Some  use  a  blanket,  and  fold  it  over  the 
other  appendages,  thereby  keeping  up  the  temperature 
and  moisture  for  a  long  time.  It  is  advisable  to  con- 
tinue the  fomentation  twice  during  the  day  and  night 
for  six  hours,  alternating  with  the  oil  and  laudanum,  as 
advised.  It  should  be  continued  until  the  swelling  has 
abated,  or  until  you  can  shake  the  calf  of  the  leg. 


474  MILK-LEG. 

When  you  have  arrived  at  this  stage,  adopt  Dr.  Phy- 
sick's  remedy  of  applying  a  narrow  blister  along  the 
whole  course  of  the  artery;  immediately  after  which 
enclose  the  limb  in  a  common  roller  bandage,  for  the 
purpose  of  facilitating  and  hastening  absorption. 

Throughout  the  complaint  you  will  necessarily  have 
to  use  anodynes^to  allay  the  pain ;  for  this  purpose  I 
generally  combine  morphine  with  ipecac.  Another 
essential  part  of  the  treatment  is  a  low  diet,  with  per- 
fect rest,  and  horizontal  position,  as  advised. 

In  cases  of  extreme  prostration,  whether  from  the 
absorption  of  pus,  or  the  exhaustion  of  the  suppurating 
process,  it  will  be  necessary  to  support  the  system ;  to 
do  which  you  will  give  wine-whey,  animal  broths,  am- 
monia or  infusion  of  Peruvian  bark. 

During  convalescence,  should  considerable  oedema 
(swelling)  remain,  it  will  be  corrected  by  the  bandage 
and  the  moderate  use  of  diuretics,  such  as  bitartrate  of 
potassa  and  squill.  She  should  use  no  more  exercise 
than  is  essentially  necessary,  until  the  recovery  is  per- 
fect. The  leg,  it  is  said,  remains  sometimes  swelled  for 
thirty  years.  The  calibre  of  the  vein  is  diminished,  and 
in  some  instances,  destroyed.  It  is  all  important  to 
bear  in  mind,  not  to  walk  too  soon ;  and  not  then,  unless 
you  have  a  tightly  laced  gaiter  above  the  knee,  which 
should  be  worn  for  months  after  the  cure. 

I  must  not  forget  to  call  your  attention  to  the  com- 
pound tincture  of  colchicum,  which  is  a  superior  remedy 
in  milk  leg.  You  make  the  tincture  as  follows  : — Take 
of  colchicum  seed,  two  ounces;  black  cohosh  root,  in 
powder,  three  ounces ;  boiling  water,  eleven  fluid  ounces ; 
alcohol,  twenty-one  ounces.    Add  the  boiling  water  to 


BLEEDING  AT  THE  NOSE. 


475 


the  drugs,  and  when  cold,  add  the  alcohol.  Macerate 
for  two  weeks ;  express  and  filter  through  paper. 

It  may  be  made  by  adding  together  equal  parts  of  the 
tinctures  of  colchicum  seed  and  black  cohosh  root. 
Dose,  ten  to  sixty  drops,  or  more,  as  circumstances  indi- 
cate, every  one,  two,  or  four  hours. 


HEMORRHAGES, 

EPISTAXIS. 

Bleeding  at  the  nose. — The  mucous  membrane  of  the 
nose  is  decidedly  the  most  frequent  seat  of  haemorrhage; 
there  is  a  net  work  of  blood  vessels  expanded  on  the 
internal  surface  of  the  nostrils,  which  have  a  very  thin 
and  delicate  integument  for  their  protection.  Any  thing 
that  has  a  tendency  to  produce  congestion  of  these  vessels, 
or  too  great  a  determination  of  blood  to  the  head,  in 
either  case  those  delicate  blood  vessels  of  the  nose  are 
easily  ruptured. 

In  general  the  blood  only  escapes  from  one  nostril ; 
the  haemorrhage  is  generally  preceded  by  a  fullness  or 
sense  of  weight  about  the  head ;  but  if  it  is  of  an  active 
character,  you  frequently,  before  an  attack,  have  signs 
of  a  local  disorder,  such  as  vertigo,  flushing  in  the  face, 
heat,  and  a  disagreeable  itching  in  the  nostrils,  a  throb- 
bing of  the  temporal  arteries,  redness  of  the  eyes,  some- 
times disordered  vision,  buzzing  in  the  ears,  and  not 
unfrequently  accompanied  with  coldness  of  feet  and 
hands,  with  chilly  sensations,  and  almost  sure  to  be 
preceded  by  costiveness. 


476 


BLEEDING  AT  THE  NOSE. 


It  is  very  irregular  in  its  occurrence,  duration  and 
progress;  the  ha3morrhage  is  so  extensive  at  times  as 
to  justify  alarm,  and  it  has  been  known  to  prove  fatal. 

The  most  dangerous  form  of  the  disease  is  when  the 
bleeding  is  of  a  strictly  passive  character,  in  such  cases 
great  quantities  of  blood  are  sometimes  lost,  and  it  is 
quite  difficult  to  arrest  it ;  this  variety  is  generally  con- 
fined to  persons  of  a  sanguine  and  plethoric  habit,  and 
those  who  have  not  advanced  to  manhood;  and  it  is 
frequently  the  result  of  a  peculiar  weakness  in  the 
vessels  of  the  part,  or  in  persons  in  the  decline  of  life. 

I  have,  in  this  climate,  seen  cases  occur  from  the 
result  of  lesions  elsewhere ;  and  it  is  by  no  means  un- 
common in  our  malarious  districts  to  find  persons  with 
enlarged  spleens  or  indurating  livers  particularly  liable 
to  this  form  of  haemorrhage. 

Causes. — It  occurs  at  all  ages,  and  when  no  predispo- 
sition to  this  variety  of  haemorrhage  exists  it  is  seldom 
produced  except  by  direct  violence,  generally  under  such 
circumstances  it  is  of  no  consequence ;  if,  however,  there 
should  be  a  predisposition  to  it,  in  such  cases  there  may 
not  only  be  danger  from  the  flow  of  blood  itself,  but  of 
haemorrhage  from  other  parts,  as  haemoptysis,  (spitting 
of  blood.) 

It  has  been  taught  from  Hippocrates  down  to  the  pre- 
sent time,  that  they  who  have  been  much  subject  to 
epistaxis,  (bleeding  at  the  nose)  when  young,  are,  at  a 
later  period,  liable  to  haemoptysis,  (spitting  of  blood,) 
and  phthisis  pulmonalis,  (consumption,)  and  it  is 
asserted  also  that  they  suffer  from  haemorrhoides,  (piles.) 

The  exciting  causes  are  very  appreciable,  such  as  a 
blow  upon  the  nose,  blowing  the  nose,  the  exercise  of 
running,  tight  cravats,  and  in  general  any  agency  capa- 


BLEEDING  AT  THE  NOSE. 


477 


ble  of  producing  a  determination  of  blood  to  the  head, 
or  any  violent  effort  that  prevents  the  return  of  blood 
from  the  head,  whilst  its  flow  thither  is  favored,  may 
serve  as  causes  for  this  haemorrhage,  hence  stooping  or 
lying  with  the  head  low  frequently  give  occasion  to  it. 

There  is  frequently  a  predisposition  so  strong  to  it  as 
to  bring  on  this  result  without  the  intervention  of  any 
exciting  cause ;  we  have  found  it  to  exist  to  this  degree 
frequently  in  our  febrile  and  inflammatory  complaints. 
Bleeding  at  the  nose  is  a  common  occurrence  in  bilious 
fever,  and  some  assert  that  it  is  also  in  typhus. 

Treatment. — In  general,  bleeding  at  the  nose  soon 
ceases,  and  seldom  requires  the  aid  of  a  physician, 
unless  it  is  in  the  passive  form,  which  should  be  sup- 
pressed as  speedily  as  possible,  as  it  sometimes  proves 
very  serious. 

The  patient  should  be  placed  in  a  sitting  posture,  and 
whilst  the  flow  of  blood  continues,  the  head  should  be 
kept  elevated,  the  air  of  the  chamber  cool  and  fresh — 
you  should  now  attempt  to  divert  the  blood  from  the 
head  and  throw  it  back  upon  the  extremities,  which 
must  be  effected  by  means  calculated  to  equalize  the 
circulation.  A  very  distinguished  author  advises  im- 
mersing the  feet  in  a  tub  of  warm  ley  water,  and  hyssop 
or  pennyroyal  tea  taken  to  produce  perspiration.  If  this 
should  fail,  cold  water  should  be  applied  (ice  is  pre- 
ferable) to  the  outside  of  the  nose,  head  and  neck. 
Immersion  of  the  arms  in  cold  water,  and  the  applica- 
tion of  cold  to  the  armpits,  groins,  or  other  very  sensi- 
tive parts,  have  also  been  recommended.  Dashing  cold 
water  on  the  genital  organs  is  a  popular  remedy,  and  is 
said  to  have  had  an  instantaneous  effect  in  suppressing 
it. 


478 


BLEEDING  FROM  THE  NOSE. 


M.  Negreir  communicated  a  mechanical  agency  to  the 
Royal  Academie  des  Sciences  of  Paris,  for  arresting  epis- 
taxis.  I  have  tried  it  frequently,  in  ordinary  cases,  with 
perfect  success.  He  makes  the  patient  stand  up,  with  the 
head  elevated ;  the  nostril  from  which  the  blood  flows,  is 
compressed  by  the  finger,  and  the  corresponding  arm  is 
directed  to  be  raised  perpendicularly,  and  to  be  kept  in 
that  position  for  about  four  minutes.  The  explanation 
given  by  M.  Negrier,  of  this  fact,  is  as  follows : — When 
an  individual  stands  in  the  ordinary  posture,  with  his 
arms  hanging  down,  the  force  required  to  propel  the 
blood  through  his  upper  extremities,  is  about  half  that 
which  would  be  required  if  his  arms  were  raised  per- 
pendicularly above  his  head.  But,  since  the  force  that 
sends  the  blood  through  the  carotid  arteries  is  the  same 
as  that  which  causes  it  to  circulate  through  the  arteries 
of  the  arm,  and  there  is  nothing  in  the  mere  position  of 
the  arms  above  the  head,  to  stimulate  the  heart  to 
increased  action ;  it  is  evident,  that  a  less  vigorous  cir- 
culation through  the  carotids,  must  result  from  the 
increased  force  required  to  carry  on  the  circulation 
through  the  upper  extremities. 

Dr.  Dain  reports  several  severe  cases  of  nasal  hsenior- 
rhage,  which  he  completely  arrested,  and  wrhen  the 
bleeding  was  from  both  nostrils,  by  compressing  the 
nostrils  and  raising  both  arms  above  the  head: 

Should  these  measures  fail,  a  different  class  of  agen- 
cies must  be  resorted  to ;  recourse  should  be  had  to 
astringent  injections.  A  very  distinguished  plxysician, 
usually  employs  a  strong  solution  of  alum,  in  the  pro- 
portion of  fifteen  or  twenty  grains,  or  even  more,  to  the 
fluid  ounce,  with  almost  uniform  success.  Kino,  cate- 
chu, or  extract  of  rhatany,  may  be  added  to  this  solu- 


BLEEDING  FROM  THE  NOSE. 


479 


tion,  or  used  separately,  in  the  form  of  very  strong  in- 
fusion; acetate  of  lead  may  be  used  in  the  same  way; 
the  liquid  should  be  throw  up  the  nostrils  by  means  of 
a  syringe ;  others  advise  plugging  the  nostrils  with  lint, 
dipped  in  an  astringent  solution  of  alum,  or  in  a  solu- 
tion of  kreosote,  or  of  red-oak  bark. 

Various  astringent  powders,  finely  levigated,  are  re- 
commended to  be  blown  up  the  nose,  by  means  of  a 
quill,  such  as  charcoal,  galls,  kino,  alum,  &c. ;  the  pul- 
verized gum  Arabic,  is  highly  extolled  to  be  used  as  the 
above ;  and  Dr.  Beach  says,  take  a  piece  of  smoked  beef 
that  is  very  dry  and  hard — the  more  flesh  that  has  been 
cut  off  the  better — and  grate  it ;  this  forms  a  fine  pow- 
der ;  push  this  up  the  nostril  as  far  as  possible,  and  con- 
tinue to  do  it  till  it  is  closed,  or  the  bleeding  ceases. 
He  says  he  never  knew  it  to  fail. 

Another  plan  consists  in  introducing  into  the  nostril 
a  piece  of  the  intestine  of  the  hog,  closed  at  one  end, 
then  to  inject  cold  water  forcibly  and  tie  the  other  end. 
It  is  also  recommended  to  plug  the  nostrils  posteriorly; 
it  is  advised  to  pass  a  catgut  through  the  nostrils  into 
the  mouth ;  it  is  then  drawn  out,  and  a  piece  of  sponge 
attached  to  it ;  when  it  is  drawn  it  will  press  upon  the 
posterior  nerves.  I  have  used  a  fine  piece  of  sponge, 
saturated  with  collodion,  and  passed  up  the  nostril  quick. 
It  is  but  proper  to  remark  that  direct  compression  and 
plugging  have  been  disapproved  of  by  some,  owing  to 
irritation  produced. 

After  the  bleeding  has  been  arrested,  its  return  can 
only  be  prevented  by  a  proper  consideration  of  the  cause 
that  produced  it. 

In  active  bleeding,  regulate  the  diet ;  obviate  plethora 
and  vascular  excitement ;  do  not  carry  your  system  of 


4S0 


BLEEDING  FROM  THE  NOSE. 


reduction  so  far  as  to  produce  debility;  if  there  is  a  ten- 
dency to  accumulation  of  blood,  confine  him  to  vegeta- 
bles and  milk. 

In  passive  bleeding,  your  object  in  the  intervals  should 
be,  to  impart  vigor  to  the  functions,  without  over  ex- 
citing them ;  this  to  be  effected  by  nutritious  diet,  fresh 
air  and  exercise. 

In  cases  that  occur  in  youth,  a  saline  cathartic,  with 
light  dry  diet  will  be  sufficient. 

All  great  bodily  exertions,  as  well  as  physical  or  men- 
tal excitements,  should  be  specially  avoided,  as  well  as 
a  too  long  indulgence  in  bed. 

Should  the  bleeding  occur  in  persons  whose  blood  is 
thin,  you  should  remove  this  condition  by  tonic  reme- 
dies, such  as  kreosote,  dilute  sulphuric  acid,  and  the 
preparations  of  iron. 

If  at  any  time  there  should  be  threatening  symptoms 
of  an  attack,  they  should  be  met  by  saline  cathartics, 
low  diet  and  rest. 

In  either  form,  should  the  haemorrhage  return  periodi- 
cally, at  short  intervals,  much  might  be  expected  from 
sulphate  of  quinine,  and  if  this  should  be  inapplicable, 
from  the  arsenical  medicines. 

In  all  cases,  the  practitioner  should  thoroughly  inves- 
tigate the  condition  of  the  system,  to  ascertain  whether 
there  may  not  be  some  concealed  source  of  the  haemor- 
rhage in  organic  derangements,  and  if  successful  «in  his 
search,  should  direct  his  remedies  towards  the  removal 
of  these  causes. 


BLEEDING  FROM  THE  LUNGS. 


481 


HAEMOPTYSIS. 

Bleeding  from  the  Lungs. — It  may  proceed  from  the 
mucous  membrane  of  the  air  passages,  or  from  the  air 
cells  of  the  lungs;  and  although  always  an  alarming 
disease,  yet,  if  it  be  nothing  more  than  a  simple  exhala- 
tion of  blood  from  the  bronchial  mucous  membrane,  it  is 
not  necessarily  a  dangerous  disease.  In  the  other,  where 
you  have  hemorrhage  from  the  air  cells,  it  is  highly 
dangerous,  from  the  fact  that  it  is  generally  profuse. 

The  first  feeling  generally  of  the  patient  is,  not  un- 
frequently,  an  unusual  sensation  in  the  trachea  (wind- 
pipe) or  larynx ;  and  the  mere  fact  of  spitting  of  blood, 
is  a  very  alarming  symptom  to  most  patients.  In  con- 
nection with  these  unusual  sensations  in  the  windpipe, 
there  is  an  indescribable  feeling  of  uneasiness  about  the 
chest,  with  more  or  less  oppression  in  the  breathing, 
which  induces  a  slight  cough,  followed  by  the  expecto- 
ration of  blood. 

These  preliminary  symptoms  in  an  attack  of  haemop- 
tysis, is  commonly  preceded  by  heat  and  great  soreness 
in  some  portion  of  ihe  chest ;  and  with  the  local  are 
associated  general  symptoms;  there  is  palpitation,  with 
an  accelerated  pulse,  generally  full  and  hard,  attended 
with  flushed  cheeks  and  headache,  cool  extremities; 
sometimes  irregular  chills  are  experienced,  especially  in 
the  back ;  I  have  seen  it  accompanied  with  severe  rigors 
and  febrile  symptoms. 

The  blood  which  is  spit  up  is  florid — generally  of  a 
bright  scarlet  color — and  it  is  frothy;  the  appearance  of 
the  blood  spit  up,  however,  differs  according  to  its  pre- 
cise origin,  quantity,  length  of  detention,  &c.  An  author 
of  distinguished  celebrity,  says,  where  the  quantity  ex- 
pectorated is  very  great,  it  is  less  frothy,  though  a  por- 
31 


482 


BLEEDING  FROM  THE  LUNGS. 


tion  will  still  generally  be  observed  in  this  state,  upon 
the  surface  of  the  expectorated  blood,  in  the  vessel 
which  receives  it. 

If  the  blood  has  been  detained  long  in  the  air  pas- 
sages, it  is  of  a  dark  color,  and  this  may  cause  you 
some  difficulty  in  discriminating  between  it  and  haemor- 
rhage from  the  stomach,  which  is  dark  also,  and  in  fact 
it  is  generally  black,  when  it  is  secreted  in  the  stomach ; 
it  most  generally  lays  there  until  it  becomes  coagulated, 
and  it  is  expectorated  in  clots,  larger  or  smaller ;  there 
is  another  distinguishing  feature  in  the  blood,  that  from 
the  stomach  is  never  florid  or  frothy,  you  may  distin- 
guish it  from  haemorrhage  from  the  lungs,  by  these 
symptoms ;  in  haemorrhage  from  the  lungs,  you  have 
cough  and  dyspnoea,  (difficulty  of  breathing,)  in  the 
other  you  have  nausea,  weight  in  the  stomach  and 
vomiting,  and  the  blood  discharged  is  frequently  mixed 
with  the  contents  of  the  stomach. 

In  some  cases,  the  blood  appears  in  distinct  streaks  in 
mucous  ;  in  others  it  is  intimately  blended,  causing  the 
expectoration  to  present  a  rusty  appearance,  some  have 
compared  it  to  red  currant  jelly. 

The  quantity  of  blood  varies  from  enough  merely  to 
tinge  the  expectoration,  and  at  other  times  it  is  so  great 
that  it  almost  amounts  to  vomiting,  mouthful  after 
mouthful  being  expectorated.  In  a  great  majority  of 
cases,  however,  the  loss  is  moderate,  and  not  sufficient 
to  produce  any  serious  impression  on  the  system.  Cases 
have  been  reported,  where  extraordinary  quantities  of 
blood  have  been  discharged,  and  the  patient  has  sunk 
immediately,  but  they  are  very  rare. 

When  the  chest  is  percussed,  it  emits  its  natural 
sound,  because  the  blood  is  expectorated  as  fast  as  it 


BLEEDING  FROM  THE  LUNGS. 


483 


transudes ;  for  the  same  reason  on  auscultation,  no 
sound  may  be  heard  except  the  mucous  rale  with  large 
bubbles. 

Along  with  the  phenomena  already  mentioned,  there 
are  often  present,  especially  upon  the  first  attack  of 
spitting  of  blood,  various  symptoms  ascribable  to  the 
very  natural  alarm  of  the  patient,  as  great  paleness, 
anxiety  of  countenance,  a  quickened  and  agitated,  but 
feeble  pulse,  tremblings,  faintness,  and  even  nausea. 
These,  fortunately,  have  in  many  instances  a  tendency 
to  diminish  the  haemorrhage.  In  the  subsequent  attacks, 
the  patient,  in  general,  feels  less  apprehension ;  but  the 
idea  of  great  danger,  connected  with  spitting  of  blood, 
is  so  firmly  fixed  in  the  public  mind,  that  few  are  found 
capable  of  resisting  the  impression  entirely.  When  the 
loss  of  blood  is  great,  the  effects  of  this  are  added  to 
those  of  alarm,  and  symptoms  of  great  prostration  are 
occasionally  presented. 

It  rarely  happens  that  an  individual,  if  he  live  many 
years  after  the  first  attack,  escapes  a  return  of  the 
haemorrhage  ;  and  in  very  many  cases,  the  returns  are 
frequent.  In  these  cases,  the  patient  in  general,  dies 
ultimately  of  pulmonary  consumption. 

I  have  mentioned  that  blood  is  sometimes  effused  in 
the  air  cells.  When  there  is  a  considerable  reddish  and 
very  frothy  expectoration,  with  great  oppression  of 
breathing  and  a  sense  of  impending  suffocation,  and 
when,  at  the  same  time,  an  absence  of  respiration  in  a 
certain  portion  of  the  lung,  is  indicated  by  auscultation 
and  percussion,  there  is  reason  to  suppose  that  the 
haemorrhage  may  be  of  the  kind  alluded  to.  These 
cases  are  always  alarming  and  dangerous,  but  by  no 
means  inevitably  fatal. 


484 


BLEEDING  FROM  THE  LUNGS. 


Causes. — The  causes  of  hemoptysis  (spitting  of  blood,) 
are  numerous  ;  it  occurs  more  particularly  in  those  per- 
sons disposed  to  consumption  ;  with  a  fine  soft  skin,  fair 
hair,  eyes  blue,  and  a  sanguinous  temperament;  and 
among  these,  it  occurs  more  particularly  in  those  who 
have  a  florid  color.  The  exciting  causes  are  violent 
corporeal  exertion,  either  of  the  lungs  in  speaking,  sing- 
ing, coughing,  &c,  or  of  the  body  generally,  such  as 
straining,  lifting,  or  any  violent  muscular  exercise ; 
these  frequently  induce  it,  and  especially  if  any  of  the 
influences  described  be  in  action ;  it  may  be  induced, 
also,  from  tight  lacing,  or  vascular  fullness,  or  mechani- 
cal impediment  to  the  circulation,  owing  frequently  to 
the  presence  of  tubercles  in  the  lungs. 

"It  succeeds,  at  times,  to  the  suppression  of  accus- 
tomed evacuations,  as  of  the  piles  or  menstrual  flux,  and 
recurs  periodically  at  the  times  when  these  fluxes  have 
been  expected." 

There  are  certain  morbid  affections,  which  are  espe- 
cially productive  of  this  hemorrhage,  such  as  bronchial 
or  pulmonary  inflammation,  phthisis,  (consumption) 
organic  diseases  of  the  heart,  aneurism,  and  suppression 
of  habitual  discharges,  whether  healthy  or  morbid. 

Treatment. — It  is  highly  essential  at  all  times  to 
attempt  to  arrest  the  discharge ;  the  patient  should  be 
made  easy  and  comfortable ;  his  shoulders  considerably 
elevated,  and  he  should  not  be  allowed  to  move  or  speak. 
The  air  of  the  apartment  should  be  fresh  and  cool ;  the 
room  should  be  well  ventilated.  If  he  has  a  disposition 
to  cough  he  should  restrain  it  as  much  as  possible. 

Where  the  attack  is  slight,  and  merely  limited  to  ex- 
pectoration, tinged  with  blood,  the  simplest  means  is 
generally  sufficient  for  its  removal ;  and  there  are  none 


BLEEDING  FROM  THE  LUNGS. 


4  85 


more  simple  and  always  ready,  than  that  recommended 
by  Dr.  Rush.  He  says,  pour  down  from  a  tea  to  a  table- 
spoonful  of  clean  fine  salt,  as  soon  as  possible  after 
haemorrhage  begins  from  the  lungs.  This  quantity 
generally  stops  it ;  but  the  dose  must  be  repeated  daily 
,for  three  or  four  days  to  prevent  a  return  of  the  disor- 
der. If  the  bleeding  continues,  the  salt  must  be  continued 
until  it  is  checked,  but  in  larger  doses.  I  have  heard 
of  several  instances  in  which  two  table-spoonsful  were 
taken  at  one  time  for  several  days. 

It  sometimes  excites  a  sickness  at  the  stomach,  and 
never  fails  to  produce  a  burning  sensation  in  the  throat 
in  its  passage  into  the  stomach,  and  considerable  thirst 
afterwards. 

In  vol.  1st.  of  Medical  Inquiries,  they  say  they  have 
found  this  remedy  to  succeed  equally  well  in  haemor- 
rhages, whether  they  were  active  or  passive,  or  whether 
they  occurred  in  young  or  old  people. 

The  cor /in  cercinae  exsiccatum  (dried  deer's  horn)  is  an 
eclectic  remedy  of  much  value,  especially  in  haemorrhage ; 
one  drachm  of  the  powder  may  be  given  every  hour 
until  the  haemorrhage  ceases.  It  is  frequently  adminis- 
tered by  taking  a  drachm  of  the  powder,  put  it  in  a  gill 
of  water,  (boiling)  and  you  can  give  a  table-spoonful  of 
the  infusion  every  five  or  ten  minutes. 

The  mass. of  authority  advise  the  lancet  in  this  variety 
of  haemorrhage,  but  certainty  discrimination  is  very 
important,  before  you  resort  to  such  a  remedy ;  I  have 
seen  great  injury  result  from  the  improper  use  of  the 
lancet.  Should  there  be  evidences  of  plethora  or  hype- 
remia, (congestion)  threatening  apoplexy  of  the  lungs,  in 
such  cases  I  would  not  hesitate  to  use  prompt  and  ample 


486 


BLEEDING  FROM  THE  LUNGS. 


depletion.  It  is  a  remedy  I  never  resort  to  in  ordinary 
cases. 

To  invite  the  blood  to  the  extremities,  I  generally 
immerse  the  feet  in  a  warm  ley  bath,  and  afterwards 
apply  mustard  plasters  to  the  extremities,  and  ice  to  the 
chest,  when  it  can  be  had,  and  cup  freely  over  the  chest 
and  shoulders. 

Should  the  pulse  be  very  frequent,  and  rather  feeble 
than  strong,  I  generally  administer  a  few  drops  of  the 
tincture  of  aconite  to  reduce  the  arterial  excitement,  or 
give  ipecac,  in  sufficient  doses,  repeated  at  intervals  of 
an  hour,  until  it  produces  nausea,  frequently  bathing  the 
hands  in  hot  water,  and  applying  ligatures  around  the 
extremities  will  arrest  the  discharge.  Some  extol  digi- 
talis; its  effects,  however,  I  do  not  think  sufficiently 
active  to  be  relied  upon.  The  following  is  a  favorite 
recipe  with  many  practitioners  : 

^.    Tinct.  digitalis,  gtts.  xl. 

Acid,  hydrocyanic,  gtts.  v. 

Mucilage  gum  arabic,  fl.  3iii. 

Water,  Biiiss. 

Mix.    Give  a  fourth  part  every  four  or  five  hours. 

After  the  pulse  has  been  reduced  in  volume,  I  have 
had  good  success  with  the  following,  although  there  will 
be  many  who  will  oppose  the  opium ;  but,  nevertheless, 
it  is  a  valuable  remedy. 

1^.    Sugar  lead,  grs.  vi. 

Ipecac,  grs.  ix. 

Opium,  grs.  iss. 

Mix,  and  divide  into  six  powders,  give  one  every 
two  hours. 


BLEEDING  FROM  THE  LUNGS. 


487 


Kevulsion  is  frequently  beneficially  excited,  by  the 
administration  of  cathartics ;  those  that  produce  active 
secretion  from  the  mucous  membrane  should  be  adopted, 
and  for  this  purpose,  I  advise 


Give  one-half,  and  if  it  does  not  operate  in  three  hours, 
it  should  be  repeated ;  when  the  medicine  operates,  the 
patient  should  not  be  allowed  to  rise  from  his  bed,  but 
should  make  use  of  the  bed-pan. 

After,  as  I  have  before  observed,  you  have  sufficiently 
subdued  the  general  excitement,  acetate  of  lead  is  the 
best  remedy,  although  much  difference  of  opinion  exists 
in  regard  to  it.  I  generally  combine  it  with  a  grain  of 
ipecac,  and  give  one  or  two  grains  every  five  hours ;  if 
it  does  not  arrest  the  hemorrhage,  repeat  it  every  three 
hours;  if  this  does  not  arrest  it,  I  give  three  grains 
every  three  or  four  hours ;  you  should  not  administer  in 
all  over  thirty  grains,  as  it  might  produce  colica  picto- 
num. 

Almost  all  the  agents  that  belong  to  the  class  of 
astringents  have  been  given  in  this  disease.  Sulphuric 
acid,  in  a  dilute  state,  or  in  the  form  of  the  elixir  of 
vitriol,  eight  to  ten  drops  in  a  glass  of  water,  is  a  com- 
mon remedy;  or  a  lemonade,  made  of  dilute  sulphuric 
acid,  lemon  peel,  sugar  and  water ;  but,  if  the  experi- 
ments of  Magendie  can  be  relied  on,  sulphuric  acid  does 
not  favor  the  coagulation  of  blood,  but  the  contrary. 
When  the  case  is  attended  with  weakness  and  feebleness 
of  the  pulse,  alum  and  the  vegetable  astringents  have 
been  used  with   advantage,  such  as  kino,  catechu, 


^.    Sulphate  of  magnesia, 
Dilute  sulphuric  acid, 
Mint  water, 


fl.  giii. 


3vi. 

gtts.  xii. 


488 


BLEEDING  FROM  THE  LUNGS. 


rhatany,  geranium,  galls.  They  may  be  used  in  the 
form  of  infusion. 

The  conserve  of  roses  is  a  valuable  remedy,  under 
such  circumstances;  it  should  be  taken  in  sufficient 
quantity  and  be  persisted  in ;  it  may  be  given  to  the 
amount  of  three  or  four  ounces  a  day;  and  the  infusion 
of  wild  cherry  tree  bark,  may  be  used  advantageously 
under  similar  circumstances. 

Tannin,  at  this  stage,  has  been  highly  extolled ;  the 
following  is  a  good  recipe  for  its  administration : 

fy.    Tannic  acid,  grs.  iv. 

Pulv.  gum  arabic,  grs.  xv. 

Simple  syrup,  q.  s. 

Mix,  and  divide  into  eight  pills.  Give  one  every 
three  hours.  This  remedy  sometimes  produces  consti- 
pation, which  should  be  counteracted  by  injections. 

I  have  used  kreosote  with  advantage.  The  following 
recipe  has  been  suggested ;  I  think  well  of  it. 

^.    Kreosote,  gtts.  v. 

Mucilage  gum  arabic,  Shi. 
Syrup,  gi. 

Dose,  tea-spoonful  every  three  hours. 

Some  recommend  the  iodide  of  iron,  grs.  ii.,  in  solu- 
tion of  water,  two  or  three  times  a  day. 

As  a  hremastatic  agent,  Dr.  Copeland  extols  the  oil 
of  turpentine,  and  adduces  strong  testimony  of  its  effi- 
cacy; he  says  it  is  adapted  to  the  active  and  passive 
forms  of  hemorrhages ;  he  gives  it  in  large  doses  in  the 
active  variety  and  small  doses  in  the  passive.  In  an 
article  by  Dr.  Millshire,  he  says  it  is  one  of  the  most 
able  weapons  in  the  hands  of  the  practitioner.    My  own 


BLEEDING  FROM  THE  LUNGS. 


489 


opinion  is,  that  it  can  only  be  applicable  to  that  variety 
of  cases,  where  there  is  no  inflammatory  action;  it 
would  not  answer  in  cases  of  a  plethoric  condition. 

A  very  distinguished  author  advises  ergot  in  this 
affection,  says  he  has  seen  the  happiest  effects  result 
from  it,  he  uses  it  as  a  substitute  for  the  sugar  of  lead ; 
he  gives  ten  grains  every  two  hours,  continuing  its  use 
for  a  day  or  two.  It  should  not  be  employed  in  cases 
occurring  during  pregnancy. 

The  following  recipes  are  advised  and  have  many 
advocates : 

^.    Liquorice  root,  Si. 
Starch. 
Gum  arabic. 

 tragacanth. 

Poppy  seeds,  aa.  Sii. 
Blanched  almonds,  Siv. 
Sugar  loaf,  Sx. 

Pulverize  well  together,  and  give  in  doses  from  a-half 
drachm  to  a  drachm. 

^.    Carrageen,  (Irish  moss,)  5ss. 

Water  sufficient  to  obtain  six  ounces  of  mu- 
cilage ;  strain,  and  add 
Phosphate  of  soda,  3iss. 
Syrup  of  opium,  3iii. 
Mix  well,  and  give  tea-spoonful  every  two  hours. 

The  same  treatment  is  required  in  passive  haemorrhage 
of  the  lungs  as  for  the  active  Form,  either  variety  requires 
to  be  treated  with  some  caution. 

The  following  has  been  recommended  in  the  passive 
form : 


490 


BLEEDING  FROM  THE  LUNGS. 


fy.    Uva  ursi,       ^iss.  (bay  berry.) 
Milfoil,  si. 
Water,  3  pints, 

boil  down  to  2  pints,  and  add 

Liquorice,  £i. 

strain,  and  add 

Syrup  of  cinnamon,  gii. 
Mix  well,  and  give  in  divided  doses,  in  the  passive 
form  of  haemoptysis. 

The  oil  of  golden  rod  is  a  favorite  with  many,  taken 
in  doses  of  three  or  four  drops. 

You  must  regulate  the  diet  according  to  the  character 
and  stage  of  the  haemorrhage ;  in  the  early  stages,  when 
the  haemorrhage  is  active,  the  diet  should  be  farinaceous 
substances  and  mucilaginous  drinks,  all  cold.  If  there 
is  no  febrile  excitement,  a  more  nourishing  diet  may  be 
allowed,  such  as  farinaceous  vegetables,  with  milk,  as 
arrow  root,  sago,  rice,  &c.,  all  to  be  taken  cold.  If  the 
system  is  very  much  enfeebled,  you  can  allow  broths, 
jellies,  and  tender  poultry. 

To  prevent  a  return  of  the  haemorrhage,  you  must 
have  recourse  to  moderate  exercise,  "  free  exposure  to 
the  open  air  in  suitable  weather,"  to  avoid  the  effects  of 
vicissitudes  of  temperature,  you  should  advise  the  patient 
to  wear  flannel.  "  He  must  avoid  all  stimulating  drinks, 
and  all  other  causes  of  direct  excitement,"  you  should 
keep  the  natural  secretions  in  the  best  possible  condition. 
A  sea  voyage  is  frequently  advantageous,  and  a  change 
of  residence  into  a  warm  and  equable  climate  is  highly 
useful. 

The  patient  must  be  extremely  cautious  in  regard  to 
exertion  of  either  voice  or  body. 


BLEEDING  FROM  THE  STOMACH. 


491 


HJEMATEMESIS. 

Haemorrhage  from  the  stomach  is  not  an  unfrequent 
occurrence  in  this  climate.  Frequently  without  any 
inflammation  that  can  be  discovered,  and  generally  with- 
out much  danger,  a  quantity  of  blood  is  discharged  into 
the  stomach.  If  it  is  not  dependant  on  some  other 
disease,  I  do  not  think  the  affection  serious.  It  is  often, 
I  have  no  doubt,  symptomatic ;  when  such  is  the  case 
the  prognosis  merges  in  that  of  the  primary  malady. 

Symptoms. — Haemorrhage  from  the  stomach  is  fre- 
quently preceded  by  loss  of  appetite,  accompanied  with 
either  nausea  or  vomiting;  frequently  he  experiences 
sensations  as  if  he  had  a  load  at  the  pit  of  the  stomach, 
accompanied  with  pain  or  tenderness  over  that  organ, 
indicating  irritation  or  inflammation.  Sometimes  the 
blood,  in  addition  to  its  being  discharged  from  the 
stomach,  is  frequently  passed  by  stool,  and  in  this  cli- 
mate we  have  noticed  this  latter  symptom  more  partic- 
ularly. 

These  symptoms,  after  a  time,  yield  to  a  peculiar 
feeling  of  heat  or  distention  of  the  stomach ;  the  face 
becomes  pale,  and  the  extremities  cold,  wJiich  is  some- 
times followed  by  faintness,  dizziness,  and  evident  de- 
pression of  pulse.  These  symptoms  are  again  succeeded 
by  either  nausea  or  vomiting,  if  not  of  the  first,  most 
certainly  of  the  latter,  and  which  partially  relieves  the 
antecedent  symptoms. 

Pain  or  tenderness  in  one  or  both  hypochondriac 
regions,  (each  lateral  and  superior  region  of  the  abdo- 
men is  so  called,)  costiveness,  and  sallowness  of  skin, 
mark  a  complication  of  the  complaint  with  disease  of 
the  liver  or  spleen. 


492 


BLEEDING  FROM  THE  STOMACH. 


The  quantity  of  blood  discharged  is  frequently  very 
large.  It  accumulates  in  the  stomach,  and  becomes 
mixed  with  the  acids  and  other  contents  of  the  stomach ; 
and  when  discharged  it  is  usually  black  or  in  clots, 
resembling  frequently  flocculi  floating  in  a  colorless 
liquid,  and  having  the  appearance  of  coffee  grounds. 

The  disease  is  sometimes  periodical;  happens  espe- 
cially in  females  affected  with  amenorrhoea,  (suppression 
of  the  menses,)  and  frequently  from  the  stoppage  of  the 
hemorrhoidal  flux  in  men. 

The  only  affection  with  which  this  disease  can  be  con- 
founded is  haemorrhage  from  the  lungs.  There  is  a 
marked  difference  between  them,  which  we  have  pointed 
out  under  the  head  of  haemoptysis. 

Causes. — Blows  received  upon  the  region  of  the 
stomach  may  occasion  the  disease,  but  this  is  not  usual. 
You  will  frequently  find  it  occurring  in  persons  who  are 
dyspeptic.  I  do  not  pretend  to  say  that  it  is  a  symp- 
tom of  that  disease.  It  is  said,  and  with  truth,  to  be  a 
symptom  of  softening  of  the  stomach,  or  cancer  of  the 
stomach.  In  the  two  last  diseases  a  vessel  may  be  per- 
forated, and  death  take  place  suddenly  in  consequence 
of  the  copious  discharge.  It  is  common,  as  we  have 
observed,  in  females,  where  the  catamenial  (menses) 
discharge  is  suppressed  or  diminished.  You  observe  it 
most  frequently  in  those  who  have  resided  long  in  mala- 
rious districts,  and  who  have  suffered  with  malarious 
diseases.  It  is  frequently  complicated  with  hepatic 
(liver)  and  spleen  diseases. 

The  danger  chiefly  depends  upon  the  source  whence 
the  haemorrhage  proceeds. 

I  have  but  little  doubt  that  it  is  a  frequent  result  of 
abuse  of  alcoholic  liquors. 


BLEEDING  FROM  THE  STOMACH. 


493 


Treatment. — Your  first  object  should  be  to  soothe  and 
allay  his  excitement,  and  perfect  quiet  both  in  body  and 
mind  should  be  enjoined.  You  should  let  him  indulge 
in  cold  drinks ;  nothing  warm  should  be  allowed ;  for 
this  purpose  I  generally  let  him  have  a  table-spoonful  of 
cold  chamomile  tea  every  five  or  ten  minutes ;  bathe  his 
feet  well  in  warm  water ;  after  which  apply  mustard 
plasters  over  the  stomach  and  abdomen,  and  to  the 
extremities ;  this  will  assist  materially  in  inviting  the 
circulation  from  the  seat  of  the  disease. 

The  oil  of  turpentine,  in  this  variety  of  haemorrhage, 
is,  in  my  opinion,  the  most  valuable  remedy  we  possess. 
I  have  used  it  again  and  again  with  perfect  success.  It 
must  be  administered  in  small  doses,  not  exceeding  20 
to  30  drops,  every  three  or  five  hours ;  and  at  the  same 
time  it  is  well  to  let  him  use  a  small  portion  of  cold 
decoction  of  triUtiim  jpendulam,  (bethroot,)  or  urtica 
dioicct,  (common  nettle.) 

"  If  there  should  be  much  nausea,  retching,  and  inef- 
fectual efforts  to  vomit,  with  the  discharge  of  a  small 
portion  of  coagulated  blood,  giving  rise  to  the  suspicion 
that  much  more  of  the  blood  might  be  remaining  in  the 
stomach,  and  serving  as  a  source  of  irritation,  it  might 
be  proper  to  effect  its  complete  evacuation  by  a  mode- 
rate dose  of  ipecac. ;  this  is  highly  recommended  by 
Eberle.  But  under  ordinary  circumstances,  emetics  are 
of  doubtful  propriety." 

If  the  disease  arises  from  suppression  of  the  menses, 
means  should  be  adopted  to  restore  them  by  proper 
remedial  agents.  A  cathartic  will  frequently  act  bene- 
ficially on  the  torpid  uterus,  (womb)  and  at  the  same 
time  remove  from  the  bowels  any  effused  blood  that 


494 


BLEEDING  FROM  THE  STOMACH. 


may  have  escaped  from  the  stomach ;  for  this  purpose 
the  following  recipe  is  highly  extolled : 

^.    Sulphate  of  magnesia,  3ih. 
Dilute  sulphuric  acid,         gtts.  xxx. 
Water,  fl.  gvi. 

Mix.    Give  one-fourth  four  times  a  day. 

Where  the  remedies  have  failed  to  arrest  haemorrhage, 
I  have  given,  beneficially,  sugar  of  lead,  in  small  doses, 
in  combination  with  opium.  Others  recommend  the 
tincture  of  the  chloride  of  iron,  ten  drops  every  three 
hours.  Pure  tannin  is  a  valuable  remedy ;  it  is  recom- 
mended by  Dunglison,  as  follows  : 

3^.    Tannic  acid,  9i. 
Pul.  opii.  gr.  i. 

Mix,  and  divide  into  three  powders.  Give  one  three 
times  a  day. 

To  allay  thirst,  you  may  suffer  him  to  indulge  in  eat- 
ing ice  in  small  pieces,  or  drink  ice  lemonade,  made  with 
sulphuric  acid.  If  the  stomach  is  irritable,  the  bowels 
should  be  kept  in  a  soluble  condition  by  injectiqns ;  and 
to  allay  the  irritability,  lime  water  and  milk  is  very 
good. 

Where  you  have  reason  to  believe  that  the  haemor- 
rhage is  the  result  of  the  liver  and  spleen  being  at  fault, 
in  such  case  the  biliary  secretion  should  be  promoted  by 
an  alterative  course  of  medicine,  and  for  this  purpose  I 
would  give  the  following  : 

fy.  Podophyllin, 

(Active  principle  of  mandrake,)  grs.  v. 
Lepandrin,  9i. 
Loaf  Sugar,  9ii. 


BLEEDING  FROM  THE  BLADDER. 


495 


Mix  intimately,  and  give  two  to  four  grains  every 
three  hours,  until  the  stools  exhibit  yellow  bile. 

In  the  passive  form  of  the  disease,  the  plan  as  sug- 
gested for  passive  haemorrhage,  under  the  head  of  hae- 
moptysis must  be  pursued. 

If  faintness  comes  on,  or  the  body  becomes  cold,  the 
whole  surface,  especially  the  chest,  mast  be  rubbed  with 
stimulating  tinctures,  as  camphorated  spirits,  warm 
brandy  or  whiskey,  cologne  water,  &c.  In  every  case, 
after  the  flow  of  blood  has  been  checked,  ij^  is  necessary 
to  guard  against  its  return  by  the  strictest  attention  to 
regimen,  and  the  use  of  acid  drinks.  The  dilute  sul- 
phuric acid,  as  suggested,  in  lemonade,  will  check  the 
tendency  to  a  return  of  the  disease. 

The  diet  is  very  important  in  this  disease.  Some 
recommend  a  dry  diet ;  if  there  be  any  local  or  general 
excitement,  the  patient  should  be  confined  to  gum-water 
with  a  little  lemon  juice,  and  farinaceous  drinks.  If  the 
stomach  should  be  so  irritable  as  not  to  retain  food,  you 
must  support  the  patient  by  nutritive  enemata,  and  give 
him  small  portions  of  lime  water  and  milk,  as  heretofore 
suggested. 

HEMATURIA. 

Bleeding  from  the  Bladder. — This  is  a  discharge  of 
blood  from  the  vessels  of  the  kidneys  or  bladder;  it  may 
proceed  from  different  parts  of  the  urinary  organs;  and 
it  is  generally  very  difficult  to  decide  as  to  its  precise 
source.  It  is  rarely,  if  ever,  a  primary  disease,  but 
most  frequently  a  symptomatic  complaint. 

The  haemorrhage  is  most  generally  preceded  by  symp- 
toms indicating  irritation,  or  inflammation  of  the  part 
affected,  and  again  frequently  takes  place  without  any 


496 


BLEEDING  FROM  THE  BLADDER. 


premonitory  symptoms.  An  author  of  celebrity  says, 
that  wlien  pure  blood  is  voided  suddenly,  without  inter- 
ruption or  pain,  it  proceeds  from  the  kidneys ;  but  if  the 
blood  be  in  small  quantity,  of  a  dark  color,  and  emitted 
with  heat  and  pain  about  the  bottom  of  the  belly,  it 
proceeds  from  the  bladder.  When  bloody  urine  is  oc- 
casioned from  a  rough  stone  descending  from  the  kid- 
neys to  the  bladder,  it  is  attended  with  a  sharp  and 
excruciating  pain  in  the  back,  and  considerable  difficulty 
of  making  water.  If  the  coats  of  the  bladder  are 
injured  by  a  stone,  and  bloody  urine  follows,  it  is 
attended  with  the  most  acute  pain,  and  a  previous  stop- 
page of  water. 

The  blood  may  proceed  from  the  kidneys,  ureters, 
bladder,  or  urethra;  but  it  is  not  always  possible  to 
decide  with  certainty  upon  its  precise  source.  "In  par- 
ticular cases,  it  may  be  supposed  to  come  from  the  kid- 
neys, when  the  haemorrhage  has  been  preceded  by  pain." 
We  think  right  the  reverse  of  this,  and  believe  the 
symptoms  just  stated,  precede  haemorrhage  from  the 
bladder ;  it  is  occasioned  also  by  a  blow  upon  the  back. 
In  connection  with  the  symptoms  already  described  as 
appertaining  to  haemorrhage  from  the  Madder,  the  pa- 
tient experiences  uneasy  sensations  over  the  pubes,  or 
along  the  perineum.  I  have  attended  some  cases,  when 
it  was  the  result  of  a  fall,  receiving  the  blow  upon  the 
parts  alluded  to.  There  can  be  no  certain  diagnosis,  in 
regard  to  hemorrhage  from  the  ureters ;  it  is  necessarily 
very  uncertain. 

When  the  haemorrhage  takes  place  from  the  urethra, 
it  generally  escapes  hydrops,  or  in  a  very  small  stream; 
it  flows  both  when  the  urine  is  passed,  and  in  the  inter- 
vals ;  and  when  it  is  discharged  with  the  urine,  it  is  not 


BLEEDING  FROM  THE  BLADDER. 


497 


mixed  intimately  with  the  urine ;  and  another  symptom 
is,  he  cannot  control  the  discharge,  except  by  pressure 
upon  the  passage. 

It  frequently  accompanies  diseases  of  the  prostate 
gland,  and  I  have  seen  it  result  from  mechanical  vio- 
lence in  passing  a  catheter  along  the  canal. 

It  is  asserted,  that  in  cases  of  amenorrhoea  (suppres- 
sion of  the  menses,)  a  vicarious  discharge  sometimes 
takes  place  from  the  urinary  organs ;  and  a  similar  dis- 
charge, especially  from  the  urethra,  has  been  noticed  in 
the  course  of  purpura  haemorrhagica  (vulgarly  termed 
land  scurvy.) 

I  have  known  it  to  result  from  the  administration  of 
cantharides  internally,  and  likewise  from  spirits  of  tur- 
pentine. It  is  common  in  violent  gonorrhoea  and  stric- 
ture. The  point  to  ascertain,  if  possible,  is,  whether  it 
comes  from  the  kidneys  or  from  the  bladder;  a  very 
good  distinguishing  feature  is,  that  the  pain,  if  the  kid- 
neys are  involved,  resides  in  the  loins,  and  in  the  pelvis, 
when  it  is  in  the  bladder. 

Bloody  discharges  from  this  organ,  are  always  attended 
with  a  considerable  degree  of  danger ;  and  particularly 
so  when  attended  with  purulent  matter,  as  this  is  evi- 
dence that  there  is  an  ulcer  somewhere  in  the  urinary 
passages. 

It  is  essential  you  should  bear  in  mind  the  causes  I 
recapitulate — blows  or  falls,  violent  exercise,  jolting, 
venereal  excesses;  calculi  in  the  pelvis  of  the  kidney, 
ureters,  bladder,  or  urethra ;  cantharides,  turpentine  and 
drastic  cathartics. 

Treedment. — This  depends  a  great  deal  upon  the  loca- 
tion or  seat  of  the  haemorrhage,  and  the  treatment  must 
necessarily  be  varied  according  to  the  different  causes 

32 


408 


BLEEDING  FROM  THE  BLADDER. 


from  which  it  proceeds.  Sometimes  it  is  easily  cured, 
and  again  it  may  be  very  dangerous.  All  depends  upon 
the  cause.  If  the  haemorrhage  is  active,  it  must  be 
treated  as  active  haemorrhage  from  any  other  mucous 
membrane  ;  this  will  be  best  affected  by  rest,  abstinence, 
cooling  mucilaginous  or  demulcent  drinks,  and  cup 
freely  over  the  loins  and  perineum,  as  a  substitute  for 
the  lancet ;  cold  injections  should  be  thrown  into  the 
rectum,  combined  with  a  small  portion  of  laudanum. 
A  very  good  preparation  is  to  dissolve  an  ounce  of  gum 
arabic  in  one  gill  of  water ;  in  a  glass  of  this,  drop  in 
ten  drops  of  the  oil  of  vitriol,  this  may  be  taken  two  or 
three  times  a  day.  Where  the  haemorrhage  is  very  co- 
pious, you  must  apply  ice,  if  it  can  be  had,  over  the 
part  from  which  the  blood  proceeds.  If  the  bowels  are 
the  least  disposed  to  constipation,  they  should  be  kept 
soluble  by  the  administration  of  castor  oil  or  injections. 

Some  advise  the  use  of  stimulating  diuretics  and  as- 
tringents, especially  where  the  symptoms  are  inflamma- 
tory or  acute,  and  for  this  purpose  you  give 
1^.    Marsh  mallows,  Bui- 
Queen  of  Meadow,  giii. 
Add  four  quarts  of  water  and  boil  to  one ;  then  add 
two  ounces  of  gum  arabic,  and  half  an  ounce  of  pulver- 
ized nitre,  (saltpetre). 

Give  a  cup  full  4  or  5  times  a  day. 
A  prescription  which  I  have  used  a  great  deal,  and 
which,  I  think,  was  suggested  by  Prof.  Morrow,  is  as 
follows  : 

ty.    Sweet  spirits  of  nitre, 

Oil  of  almonds,  aa.  gii. 

Balsam  copaibse,  gi. 
Oil  of  turpentine,  Bss. 


BLEEDING  FROM  THE  BLADDER. 


499 


Oil  of  juniper, 

Oil  of  spearmint, 

Alcohol,  ^  aa.  gi. 

Shake  well,  and  give  a  fluid  drachm  three  times  a 
day,  in  some  mucilage. 

Dr.  Beach  advises  a  decoction  of  peach  tree  leaves  to 
be  used. 

Sometimes  this  hsemorrhage  is  passive,  not  accom- 
panied by  any  symptoms  of  inflammation,  though  there 
may  be  slight  irritation  ;  when  such  is  the  case,  I  think 
warm  fomentations  or  emollient  cataplasms,  preferable 
to  the  cold  applications ;  and  for  the  passive  form  of 
hsemorrhage,  you  will  find  turpentine  a  valuable 
remedy,  in  small  doses,  not  exceeding  twenty  drops 
every  three  or  four  hours ;  it  is  said  in  such  cases,  along 
with  the  ordinary  remedies  for  arresting  active  hsemor- 
rhage, the  iodide  of  iron  will  be  found  a  valuable  agent ; 
the  liquor  potassi  iodide,  from  10  to  15  drops  two  or 
three  times  a  day,  it  possesses  tonic  properties,  and  adds 
to  the  coagulability  of  the  blood. 

Sugar  of  lead  in  small  and  repeated  doses,  is  advised 
in  both  the  active  and  passive  forrns  of  the  disease. 

When  haemorrhage  takes  place  in  chronic  diseases  of 
the  kidney,  the  same  treatment  must  be  adopted,  and 
Dr.  Eliotson  says  that  in  general,  the  administration  of 
turpentine  in  small  doses,  (carefully  watching  it  lest  it 
should  irritate  the  kidneys,)  together  with  the  exhibi- 
tion of  opiates,  to  relieve  the  pain  and  procure  rest,  and 
giving  the  patient  good  support,  is  all  that  is  needful. 
We  have  only  to  treat  it  in  the  same  way  as  we  should 
treat  haemorrhage  from  other  parts.  Consider  what  is 
the  patient's  strength,  on  the  one  hand,  or  his  debility 


500 


BLEEDING  FROM  THE  BLADDER. 


on  the  other ;  consider  whether  there  are  symptoms  of 
active  inflammation,  or  how  far  the  haemorrhage  appears 
to  be  passive  only.  If  the  disease  be  not  inflammatory, 
oil  of  turpentine  is  of  great  use  here  as  in  the  alimen- 
tary canal;  but  it  is  necessary  that  you  should  care- 
fully watch  the  patient,  because  that  which  is  passive 
to-day,  may,  through  sudden  excitement,  be  active  to- 
morrow. 

Where  the  haemorrhage  succeeds  to  a  suppression  of 
the  menses,  or  bleeding  piles,  you  should  make  an  effort 
to  restore  these  discharges. 

Where  the  hemorrhage  takes  place  from  the  urethra, 
if  within  reach,  it  may  be  controlled  by  a  T  bandage,  if 
not,  cold  applications  to  the  perineum  will  generally 
give  relief. 

The  introduction  of  a  bougie  may  be  resorted  to,  but 
in  must  be  used  with  caution. 

As  general  rules,  the  application  of  mustard  plasters 
to  the  small  of  the  back,  and  cupping  immediately  over 
the  seat  of  the  pain  will  be  beneficial  in  all  cases. 

Where  you  have  a  case  unattended  with  pain  in  the 
bladder,  or  symptoms  of  irritation  in  the  kidneys,  you 
may  derive  benefit  from  the  muriated  tincture  of  iron, 
and  frequently  the  addition  of  some  gallic  acid  to  the 
tincture  of  uva  ursi,  will  be  found  to  answer  every  indi- 
cation. 

Dr.  Ebefle  succeeded  in  putting  a  permanent  termi- 
nation to  the  haemorrhage  in  a  case  of  long  standing, 
by  small  doses  of  alum  and  ipecac,  in  conjunction  with 
a  milk  diet,  mucilaginous  drinks,  and  the  occasional  use 
of  a  mild  purgative. 

fy.    Powdered  alum,  gi. 
 ipecac,  $i. 


IMMODERATE  FLOW  OF  THE  MENSES.  501 

Mix,  and  divide  into  ten  equal  parts,  one  to  be  taken 
morning,  noon  and  night. 

If  the  blood  should  become  coagulated  in  the  bladder 
and  obstruct  the  passage  of  urine,  a  catheter  should  be 
introduced  to  break  it  up,  or  warm  mucilaginous  sub- 
stances should  be  thrown  into  the  bladder  through  a 
catheter. 

Every  thing  that  would  have  a  tendency  to  invite  a 
determination  of  blood  to  the  diseased  organs  must  be 
avoided. 

MENORRHAGIA. 

Bleeding  from  the  womb. — In  accordance  with  its  deri- 
vation, it  would  in  strictness  be  an  increased  flow  of  the 
menses,  and  in  this  place  I  will  consider  it,  without 
any  regard  to  those  haemorrhages,  connected  with  ges- 
tation. 

In  health  the  menses  appear  about  every  four  weeks, 
and  continue  for  about  four  days,  and  the  amount  dis- 
charged upon  an  average  is  about  six  ounces ;  it  very 
frequently  happens  that  the  discharge  is  much  more 
copious  than  this,  and  at  times  there  is  considerable 
flooding,  the  intervals  between  the  discharges  may  be 
longer  or  shorter.  When  there  is  flooding  I  am  of  the 
opinion  it  is  combined  with  haemorrhage  from  the  uterus. 
There  are  many  cases  where  the  discharge  is  large,  yet 
it  is  not  morbid,  requiring  no- medical  assistance,  nor  can 
it  be  regarded  as  a  disease.  "  There  are  some  females 
who  always  menstruate  largely,  but  whose  health  does 
not  appear  to  suffer;  but  when  the  discharge  takes 
place  more  frequently  and  freely  than  usual,  and  mani- 
festly produces  an  injurious  effect  on  the  general  health, 


502 


IMMODERATE  FLOAT  OF  THE  MENSES. 


it  is  a  condition  which  requires  the  attention  of  the 
practitioner. 

Some  authors  divide  the  haemorrhage  into  the  active 
and  passive,  and  a  very  distinguished  author  says,  there 
is  a  real  foundation  for  this  division ;  this  division  is  not 
recognized  by  many  authors.  He  says  the  difference  is 
simply  this,  that  in  the  former,  (active)  the  blood  is 
extravasated  in  consequence  of  an  irritation  or  increased 
action  in  the  vessels  themselves ;  in  the  latter,  (passive) 
it  flows  through  the  unresisting  orifices  merely  upon  the 
principle  of  gravitation,  or  under  the  impulse  of  the 
general  circulating  force. 

Causes. — Whatever  tends  to  produce  determination 
of  blood  to  the  womb  may  cause  this  disease,  such  as 
sedentary  habits,  the  free  use  of  stimulating  food  and 
drink,  heated  rooms,  and  warm  bathing  carried  to 
excess.  It  is  said  in  the  American  Encyclopoedia  (Medi- 
cal,) that  it  is  produced  also  from  a  contrary  set  of 
causes,  to  these  I  have  assigned,  such  as  scanty  and  un- 
wholesome food,  bad  air,  exposure  to  cold,  privations  of 
all  kinds,  and  diseases  which  impair  the  digestive  func- 
tions, predispose  to  the  passive  form  of  this  disease,  by 
impoverishing  or  depraving  the  blood.  Others  contend 
that  it  is  produced  from  tight  lacing,  habitual  constipa- 
tion, congestion  of  the  portal  circulation,  from  diseases 
of  the  liver  or  spleen;  it  is  frequently  induced  by  too 
great  exertion,  inordinate  dancing,  mechanical  irrita- 
tions, excessive  sexual  indulgence,  and  frequently  from 
fear  or  anger. 

Some  contend  that  cantharides,  oil  of  turpentine, 
savine,  aloes,  as  well  as  irritating  diseases  of  the  bladder 
and  urinary  organs,  sometimes  produce  it. 


IMMODERATE  FLOW  OF  THE  MENSES.  503 

Those  who  are  predisposed  to  the  disease  should  avoid 
all  severe  exercise  in  the  upright  posture. 

Symptoms. — In  many  instances  various  premonitory 
symptoms  are  noticed  for  days  before  the  discharge 
takes  place,  such  as  headache,  giddiness,  shortness  of 
breath,  a  feeling  of  weight  or  fullness  in  the  region  of 
the  womb,  pains  in  the  back  and  loins,  slight  swellings 
of  the  external  parts  of  generation,  some  degree  of 
thirst,  and  a  frequent  strong,  hard  pulse.  Occasionally 
the  intervals  are  not  longer  than  two  or  three  weeks ; 
this  produces  prostration,  and  frequently  also  produces 
this  haemorrhage,  the  sjonptoms  which  attend  are  chilli- 
ness, unusual  fatigue  in  exercise,  the  patient  is  extremely 
pale,  and  suffers  much  from  headache  and  ringing  in  the 
ears;  the  respiration  becomes  hurried  upon  the  slightest 
effort,  accompanied  with  pains  in  the  back  and  coldness 
of  the  extremities.  The  pulse  is  feeble,  and  rendered 
very  frequent  by  the  slightest  exertion.  The  returns  of 
the  haemorrhage  become  more  irregular,  and  its  duration 
longer.  The  discharge  of  blood  is  followed  by  colored 
serum,  and  this  not  unfrequently  by  a  profuse  leucOr- 
rhea,  (a  discharge  of  a  white,  yellow  or  greenish  mucus.) 
The  slightest  causes  are  sufficient  to  induce  an  attack. 
At  length  the  patient  is  scarcely  ever  free  from  hsemor- 
hage;  which  varies  only  from  the  extravasation  of  coagu- 
lable  blood,  to  that  of  a  thin,  bloody,  serous  fluid.  The 
general  symptoms  are  still  further  aggravated.  Sallow- 
ness  of  complexion  or  excessive  pallor,  great  emaciation, 
a  very  feeble  and  excitable  pulse,  respiration  short,  cede- 
matous  (swelling)  extremities,  and  sometimes  a  general 
dropsical  tendency,  with  derangement  of  the  digestive 
and  nervous  functions,  mark  the  extreme  prostration  of 
the  system. 


504 


IMMODERATE  FLOW  OF  THE  MENSES. 


Treatment. — This  must  be  conducted  on  general  prin- 
ciples ;  and  I  would  here  remark,  that  this  super-abun- 
dant discharge  is  more  common  among  married  women 
than  virgins. 

If  the  patient  be  plethoric,  bleeding  is  universally 
advised.  I  have  never  yet  met  a  case  that  I  did  not 
control  without  the  use  of  the  lancet.  You  should,  in 
active  cases,  give  a  saline  cathartic.  The  following  will 
answer : 

Epsom  Salts,  Bii. 
Warm  water,  gvi. 
Compound  tincture  of  senna,  Sss. 
Syrup  of  roses,  oii. 
Mix.    Take 'two  table-spoonsful  for  a  dose. 

This  will  remove  any  existing  constipation.  This 
should  be  combined  with  nauseating  diaphoretics,  to  les- 
son the  arterial  excitement,  together  with  rest,  cool 
drinks,  &c.  Diet  alone  of  farinaceous  substances.  This 
will  be  sufficient  to  meet  the  constitutional  indications 
in  active  cases.    You  can  give  the  diaphoretic  powder. 

1^.    Powdered  opium,  3ss. 

 camphor,  3ii. 

 ipecac,  3i- 

Cream  of  tartar,  Si- 
Mix  them  well.    Give  five  grains  every  two  or  three 
hours. 

In  plethoric  individuals,  the  patient's  feet  should  be 
immersed  in  warm  water.  I  generally  apply  cloths  wrung 
out  of  vinegar  and  spirits  to  the  abdomen  and  vagina, 
and  let  them  use  a  strong  decoction  of  fleet  bane  or  beth- 
root.  During  the  time  she  must  be  confined  to  the  hori- 
zontal posture,  on  a  mattrass  or  couch. 


IMMODERATE  FLOW  OF  THE  MENSES.  505 

Where  there  is  considerable  haemorrhage  from  the 
vagina,  which  resists  in  any  degree  these  remedies, 
you  should  then  resort  to  such  as  seem  to  exert  an  influ- 
ence specifically  over  the  uterine  organs ;  for  this  pur- 
pose Dr.  Meigs  recommends  the  wine  of  secale  cornutum, 
(ergot)  a  tea-spoonful  three  times  a  day.  And  it  is  here 
you  can  administer  that  valuable  remedy,  as  suggested 
in  hemorrhage  from  the  lungs,  and  it  will  fulfil  your 
expectations;  I  allude  to  the  cornu  corvinaa  exsicca- 
tum  (dried  deer's  horn)  it  is  of  immense  value  in  menor- 
rhagia  and  uterine  haemorrhage.  You  can  give  one 
drachm  of  the  pulverized  powder  every  half  hour  until 
the  discharge  ceases. 

I  have  used,  beneficially,  rhatany  and  kino  in  the  fol- 
lowing proportions  : 

Ext.  rhatany,  9i. 
Pul.  kino,  q.  s. 

Make  into  eight  pills.    Give  one  every  two  hours. 

Some  recommend  monesia,  three  grains,  every  hour 
or  two.  Prof.  Simpson  speaks  in  high  terms  of  gallic 
acid,  in  doses  from  ten  to  twenty  grains,  made  into  pills, 
in  the  twenty-four  hours. 

Some  recommend  the  tincture  of  cinnamon.  I  have 
used  it  with  success.  It  should  be  given  from  thirty  to 
sixty  drops  every  hour  or  two. 

If  this  does  not  check  the  discharge,  let  the  patient 
drink  alum  whey. 

Should  the  haemorrhage  still  continue,  efforts  should 
be  made  to  arrest  it  by  producing  contraction  by 
haamastasis,  as  advised  in  uterine  haemorrhage. 

I  have  frequently  given  the  sugar  of  lead  in  combina- 
tion with  opium  and  ipecac ;  one  or  two  grains  of  the  former, 


506  IMMODERATE  FLOW  OF  THE  MENSES. 

and  small  portions  of  the  latter  may  be  administered 
every  two  hours.  "  When  the  haemorrhage  is  alarm- 
ingly copious,  it  is  necessary  to  employ  local  measures 
conjointly  with  the  general.  Of  these,  cloths  wrung  out 
of  very  cold  wrater  or  spirits,  or  bladders  containing  ice, 
may  be  applied  about  the  pelvis,  over  the  pubis,  or  to 
the  loins  and  back."  Should  cold  not  prove  effectual,'you 
can  then  resort  to  the  tampon,  which  is  used  for  plug- 
ging the  vagina,  and  which,  in  the  ordinary  state  of  the 
uterus,  can  scarcely  fail.  In  an  article  from  the  Cyc.  pf 
Pract.  Med.,  it  is  advised  to  take  a  dossil  of  lint,  or 
a  fine  cambric  handkerchief  may  be  gradually  intro- 
duced into  the  vagina  up  to  the  os  uteri,  so  as  to  fill  the 
vagina  firmly  throughout  its  whole  extent.  Many  pre- 
fer soaking  the  material  previously  in  some  astringent 
liquid ;  and  this  is,  perhaps,  still  more  efficacious.  If  a 
plug  produce  pain  it  must  be  withdrawn ;  and,  at  all 
events,  it  should  not  be  allowed  to  remain  more  than 
twenty-four  hours,  because  it  is  apt  to  become  very 
offensive  and  irritating  from  the  putrifaetion  of  the  dis- 
charge. On  withdrawing  it,  unless  it  be  done  very 
gently  and  gradually,  a  fresh  discharge  of  blood  is  apt 
to  be  occasioned;  but  it  can  easily  be  restrained  by 
another  plug,  or  some  of  the  other  remedies. 

In  cases  where  the  system  and  uterus  are  both  relaxed, 
and  the  haemorrhage  assumes  a  passive  character,  in 
this  variety  sulphate  of  zinc,  sulphate  of  iron,  tincture 
of  chloride  of  iron,  and  sulphuric  acid,  are  most  esteemed. 
Astringent  injections  are  advised,  consisting  of  alum  dis- 
solved in  an  infusion  of  kino  or  catechu,  or  a  solution  of 
sugar  of  lead,  may  be  thrown  into  the  vagina.  Some 
give  the  sulphate  of  zinc,  two  grains,  and  sulphate  of 
copper,  (blue  vitriol)  one  quarter  of  a  grain,  repeated 


IMMODERATE  FLOW  OF  THE  MEXSES. 


507 


three  or  four  times  a  day ;  this  course  would  be  benefi- 
cially assisted  by  the  aromatic  tinctures,  such  as  cinna- 
mon and  ginger. 

In  long  standing  cases,  where  the  system  is  perfectly 
prostrated,  you  might  endeavor  to  stimulate  the  uterine 
organs  by  applying  a  blister  to  the  sacrum,  and  giving 
small  doses  of  cantharides,  and  keeping  the  bowels  in  a 
soluble  condition  with  rhubarb  and  castile  soap. 

The  diet  in  every  form  of  the  disease,  must  be  regu- 
lated according  to  the  symptoms.  If  plethora  exists, 
it  must  be  restricted;  if,  on  the  other  hand,  there  is 
debility,  the  diet  should  be  nutricious,  that  which  is 
easy  of  digestion ;  malt  liquor  and  wine  may  be  allowed. 

I  attach  some  recipes,  that  I  have  not  alluded  to  in 
the  treatment,  but  which  evidently  exert,  in  many  cases, 
a  good  influence. 

fy.    Powdered  catechu,  3i. 

Confection  of  opium,  grs.  xii. 

Aromatic  confection,  q.  s. 

Make  a  bolus,  to  be  taken  twice  a  day. 
1^.    Powdered  Peruvian  bark,  gi. 
Isinglass,  5iss. 
Mix,  and  divide  into  sixteen  powders.    Dose  from 
three  to  six  a  day,  in  passive  menorrhagia. 

^.    Euphorbia  hypericifolia,  (black  puslam,)  Bss. 

Boiling  water,,.  1  pint. 

Infuse  for  half  an  hour,  and  strain.    Give  wine- 
glassful  three  times  a  day. 
fy.    Ammoniated  iron, 
Aromatic  powder, 
Ext.  of  Peruvian  bark, 
Alum,  aa.  5ss. 

Oil  of  cinnamon,  gtts.  xii. 


508 


FLOODING. 


Mix  into  a  mass,  and  form  pills  of  two  grains  each. 
Give  from  four  to  six,  morning  and  evening. 

fy.    Powdered  alum,  51. 

Sugar  of  milk,  3ss. 

Powdered  cinnamon,  grs.  xv. 

Milk,  2  pints. 

Boil,  and  strain  when  coagulated.  This  to  be  taken 
during  the  day. 

UTERINE  HEMORRHAGE. 

Flooding. — Copious  and  profuse  floodings  occur  under 
very  different  states  of  the  constitution.  I  wish  to  call 
your  attention  especially  to  those  profuse  evacuations 
which  frequently  take  place  after  confinement.  Our 
treatment,  as  suggested  for  immoderate  flow  of  the 
menses,  may  be  consulted  with  advantage. 

It  is  a  disease  so  common  in  our  climate,  from  the 
fact  our  summers  are  so  long,  and  the  heat  so  great,  that 
the  general  system  becomes  very  much  relaxed ;  other 
causes  are  assigned,  but  I  give  this  only  as  a  reason  for 
its  frequency. 

You  know  there  is  haemorrhage,  from  the  common 
symptoms  which  indicate  the  loss  of  blood.  Dr.  Rams- 
botham  says : — The  color  vanishes  from  the  cheeks  and 
lips;  the  pulse  flags;  fainting  occurs;  the  breathing  be- 
comes laborious,  and  drawn  with  sighs ;  the  extremities 
lose  their  warmth;  jactitation  (extreme  anxiety)  ensues, 
and  perhaps  vomiting.  Vomiting,  indeed,  is  not  a 
universal  symptom  of  loss  of  blood,  and  seldom  comes 
on  until  the  system  is  much  depressed.  Under  great 
exhaustion,  I  consider  it  a  good  sign,  rather  than  a  bad 
one,  because  it  shows  that  the  nervous  system  is  not 


FLOODING.  509 

deadened,  but  that  impressions  are  still  kept  up  between 
parts  remote  from  each  other,  by  means  of  sympathy; 
and  I  think  also,  that  the  very  effort  of  vomiting  tends 
sometimes  to  induce  contraction  in  the  uterus,  and  may 
thus  be  the  means  of  preservation. 

We  know,  too,  that  the  woman  is  flooding,  if  it  be 
external,  by  an  examination  of  the  linen.  Sometimes 
we  find  a  quantity  of  coagula  expelled  upon  the  nap- 
kins ;  at  others,  that  part  of  the  bed  in  which  she  lies 
is  soaked  with  blood,  and  no  misapprehension  can  arise 
as  to  the  cause  of  the  diminished  vital  energy.  But  the 
hasmorrhage  may  be  internal,  and  concealed.  Still  our 
means  of  diagnosis  are  easy  and  certain ;  the  simple  ap- 
plication of  the  hand  over  the  uterine  tumor  will  be 
sufficient  to  assure  us  of  its  state;  and  by  the  sensation 
it  conveys,  we  judge  whether  the  blood  is  pent  up  within 
its  cavity.  If  we  find  the  organ  large,  soft,  and  flaccid ; 
if  it  yield  to  the  hand,  and  becomes  harder  when  pres- 
sure is  made  upon  it,  and  if  then  blood  passes  out  of  the 
vagina  with  a  gurgling  noise,  we  can  be  at  no  loss  to 
declare  the  case  one  of  concealed  hemorrhage.  But, 
on  the  contrary,  if  the  patient  continue  fainting,  while 
there  is  no  external  flow — if  we  find  the  uterus  as  small 
as  a  foetal  head,  and  hard,  and  observe  no  relaxation  in 
its  structure — we  must  seek  some  other  cause  for  the 
symptoms  of  depression,  besides  loss  of  blood; — the 
syncope  (fainting)  is  independent  of  ha3morrhage  from 
the  womb. 

Treatment. — Under  hemorrhages,  after  the  expulsion 
of  the  placenta,  our  indication  is  to  evacuate  the  uterus, 
so  as  to  ensure  the  closure  of  its  cavity,  and,  if  necessary, 
to  rouse  the  flagging  powers  by  the  judicious  use  of 
stimuli.    Both  outward  applications  and  manual  opera- 


510 


FLOODING. 


tions  will  assist  us  in  the  accomplishment  of  our  purpose. 
Pressure  and  the  application  of  cold  will  often  of  them- 
selves prove  sufficient  to  restrain  the  flow,  and  they  may 
be  used  in  combination. 

Called  then  to  a  case  of  this  description,  the  first 
means  to  be  employed  is  the  grasping  pressure  of  the 
hand  to  the  uterine  tumor  itself.  It  is  not  enough 
merely  to  lay  the  open  palm  upon  the  abdomen  and 
press  steadily  and  flatly,  but  a  squeezing  or  kneeding 
action  should  be  used,  by  which  the  organ  is  prevented 
from  filling  and  becomes  distended  with  blood,  and  its 
fibres  also  are  stimulated  to  contract.  It  is  not  unlikely 
the  patient  may  complain  of  the  pain  we  are  putting  her 
to.  She  may  be  desirous  that  our  hand  should  be  re- 
moved. If  the  pain  she  experiences,  however,  be  that 
of  uterine  contraction,  her  entreaties  must  be  disregard- 
ed ;  because  upon  contraction  alone  her  ultimate  safety 
will  depend.  At  other  times  she  will  not  allow  us  to 
leave  her  for  a  single  moment,  she  feels  so  much  comfort 
from  the  pressure  of  the  hand  and  from  the  support 
which  the  abdominal  contents  receive,  and  she  experi- 
ences such  a  sensation  of  sinking  when  that  pressure  is 
removed  that  she  feels  convinced  she  will  faint  if  it  be 
omitted.  While  hemorrhage  is  going  on  with  any  ac- 
tivity, I  place  no  reliance  on  a  bandage,  however  tight 
it  may  be  drawn,  or  with  whatever  local  compresses  its 
action  may  be  aided.  1  cannot  think  any  fold  of  linen 
applied  over  the  uterine  region,  nor  any  thing  in  the 
shape  of  a  tourniquet,  as  has  been  recommended,  can 
secure  contraction  in  a  manner  at  all  to  be  compared  to 
the  grasping  pressure  of  the  hand. 

We  have  proof,  indeed,  that  even  the  pressure  of  the 
hand  will  not  always  produce  the  desired  effect ;  but 


FLOODING. 


511 


other  means  are  in  our  power,  efficacious  and  of  easy 
application;  and  of  these  cold  may  next  be  resorted  to. 
A  napkin,"  soaked  in  vinegar  and  water,  may  be  suddenly 
laid  upon  the  hypogastric  region,  (the  lower  part  of  the 
abdomen)  and  the  uterus  will  often  answer  the  stimulus 
immediately.  A  succession  of  cold  cloths  may  be  used 
in  this  way,  so  as  to  keep  the  temperature  of  this  part 
of  the  person  below  the  standard,  and  pressure  may  be 
used  occasionally  at  the  same  time.  Should  the  bleed- 
ing, however,  still  continue,  and  the  faintness  increase 
rather  than  diminish,  the  means  I  next  adopt  (and 
sometimes  this  is  much  more  useful  than  any  other 
mode  of  applying  cold,)  is  •  dashing  a  quantity  of  cold 
water  upon  the  lower  part  of  the  abdomen.  A  better 
plan  is  to  expose  the  abdomen  fully,  and  turn  the  water 
in  a  stream  from  a  distance  of  two  or  three  feet,  this  I 
conceive  to  be  the  best  mode  of  applying  water.  This 
may,  perhaps,  appear  a  rough  and  neither  a  very  refined 
nor  very  delicate  mode  of  treatment ;  but  the  case  is  of 
a  highly  dangerous  character,  and  all  other  considera- 
tions must  give  way  to  ensuring  the  patient's  safety. 
It  is  a  universal  observation,  that  a  slight  degree  of  cold 
applied  suddenly  and  with  a  shock,  will  produce  a 
greater  effect  than  a  more  intense  one  continued  for 
some  time. 

Dr.  Gooch  gives  us  an  instance  in  which  the  uterus 
was  stimulated  to  contract  by  a  quantity  of  cold  water 
thrown  suddenly  from  an  ewer  on  the  abdomen, 
although  it  had  not  answered  to  the  application  of  ice, 
which  had  been  previously  used  for  a  considerable 
period. 

We  may,  however,  still  be  foiled,  and  must  resort  to 
other  measures,  and  here  I  would  advise  the  use  of 


512 


FLOODING. 


HaBmastasis,  (which  will  explain  itself,)  and  I  cannot 
refrain  from  giving  you  a  portion  of  a  lecture  delivered 
by  Professor  Buchanan,  upon  this  important  agent, 
more  especially  in  connection  with  uterine  haemorrhage. 
He  says,  "  the  simple  ligature  is  all  sufficient.  If  you 
tie  a  pocket  handkerchief  or  any  suitable  cord,  around 
the  upper  arms  or  thighs,  and  tighten  it  by  an  inserted 
stick  sufficient  to  check  the  venous  blood,  but  admit  the 
passage  of  the  arterial  blood,  you  will  in  a  short  time 
have  the  blood  vessels  of  the  limb  very  greatly  distended. 
Four  ligatures  applied  in  this  manner  to  the  arms  and 
thighs,  will  in  a  few  minutes  destroy  the  balance  of  the 
circulation,  and  remove  from  the  trunk  from  one-third 
to  one-half  of  its  usual  supply  of  blood ;  an  amount  of 
reduction  which  the  most  heroic  practitioner  does 
not  attempt  with  the  lancet.  If  your  subject  be  in  a 
debilitated  or  anaemic  condition,  she  will  in  a  few 
moments  faint,  and  remain  in  suspended  animation  until 
the  ligatures  are  removed  or  loosened,  wjiich  should  be 
promptly  done. 

If  the  patient  be  plethoric,  the  blood  vessels  being 
already  well  filled,  will  not  be  susceptible  of  so  much 
additional  distention  under  the  ligatures.  They  will, 
consequently,  not  have  so  great  a  power  over  the  con- 
stitution. Hence  in  all  cases  where  the  patient  is  ple- 
thoric, and  the  constitution  of  a  firm  texture,  it  will  be 
necessary  before  you  can  assume  the  control  of  the  cir- 
culation, to  know  that  she  has  been  sufficiently  depleted 
by  cathartics,  diuretics,  and  sudorifics,  or  otherwise 
which  remove  the  watery  and  excrementitious  portions 
of  the  blood ;  and  that  the  patient  should  be  under  the 
relaxing  influence  of  gentle  nauseants,  which  relax  the 
vascular  as  well  as  muscular  system.    You  will  also 


FLOODING. 


513 


greatly  increase  the  facility  and  success  of  hcemastasis 
by  the  application  of  warmth  and  moisture  to  the 
hands  and  feet,  which  may  be  immersed  in  warm  water. 

As  a  substitute  for  the  lancet,  I  cannot  well  exagge- 
rate the  importance  of  hoemastasis,  in  controlling  severe 
congestion,  and  it  is  equally  potent  in  cases  of  hoBmor- 
rhage.  In  uterine  hemorrhage,  which  has  so  often 
baffled  the  resources  of  medicine,  a  knowledge  of  hsem-  . 
astasis  gives  you  the  power  of  retaining  the  blood  neces- 
sary to  life.  It  is  impossible  for  much  of  the  blood  to 
flow  from  the  ruptured  vessels  when  you  have  mechani- 
cally imprisoned  it  in  the  limbs.  As  soon  as  a  ligature 
has  been  applied,  and  the  blood  vessels  of  the  limbs  are 
well  filled,  the  patient  is  nearly  safe.  You  have 
imprisoned  a  sufficient  stock  of  blood  for  all  the  neces- 
sary vital  purposes ;  and  it  will  be  impossible  for  the 
heart  and  arteries  to  expel  much  of  the  portion  which 
you  have  left  in  the  trunk.  You  have  already  so 
lowered  the  action  of  the  heart  and  arteries,  that  active 
haemorrhage  from  small  vessels,  is  impossible. 

Some  extol  the  propriety  of  introducing  the  hands 
into  the  uterine  cavity,  and  assert  that  it  seldom  fails  of 
producing  the  contraction  we  desire.  The  introduction 
of  the  hand  is  always  to  be  avoided,  if,  by  any  other 
method,  we  can  produce  the  same  measure  of  good, 
without  the  chance  of  injury ;  but  yet  there  are  many 
states  that  fully  warrant  even  this  proceeding.  The 
coat  must  be  taken  off,  the  left  hand  and  arm  greased, 
and  passed  gently  into  the  uterus,  and  the  parietes  may  be 
stimulated  by  the  fingers  moved  within  it,  at  the  same 
time  that  the  right  hand  grasps  it  externally ;  or  as 
Gooch  recommends,  the  bleeding  vessels  may  be  com- 
pressed with  the  knuckles  within,  while  the  uterine 
33 


514 


FLOODING. 


tumor  is  pressed  upon  without ;  and  by  this  combina- 
tion of  external  and  internal  pressure,  it  is  seldom  that 
we  shall  not  succeed  in  putting  a  stop  to  the  discharge. 
If  there  be  any  fibrous  coagula  adhering  to  the  internal 
membrane,  these  must  be  removed  as  cautiously  as  we 
should  separate  the  placenta. 

If  the  case  does  not  yield  to  the  treatment  suggested, 
other  expedients  must  be  tried.  Some  advise  injecting 
a  quantity  of  iced  water,  vinegar,  or  other  astringent, 
into  the  uterus  itself;  advantage  may  sometimes  be 
derived  from  throwing  a  quantity  of  cold  water  into  the 
uterus ;  but  I  should  fear  using  strong  astringents  in  the 
same  way,  lest  inflammation  of  the  uterine  tissue,  or  of 
its  veins,  should  be  induced.  Ice  has  also  sometimes 
been  introduced  into  the  vagina  with  advantage,  either 
naked  or  wrapped  in  linen  or  flannel;  before  being 
passed  into  the  cavity  it  should  be  held  in  the  hand 
till  the  corners  are  rounded  off.  It  has  been  recom- 
mended that  we  should  stuff  the  vagina  with  cloths 
steeped  in  any  astringent  at  hand ;  my  experience  jus- 
tifies me  in  saying  it  is  a  safe  proceeding.  Some  object, 
and  assign  as  their  reasons,  that  the  blood  is  not  pre- 
served in  the  woman's  vessels  by  filling  the  vagina ;  it 
is  escaping  through  their  orifices,  and  collecting  in  the 
uterine  cavity;  and  as  the  womb,  by  the  pressure  of  the 
plug,  is  prevented  contracting,  the  very  object  which 
we  wish  to  gain  is  defeated  by  our  anxious  care.  I  do 
not  think  so. 

It  is  advised  to  put  the  child  to  the  breast  as  an  effi- 
cacious means  of  producing  uterine  contractions. 

As  regards  remedies,  opium,  acids  and  ergot  are  the 
chief.  [Consult  our  article  on  immoderate  flow  of  the 
menses.]    We  cannot  conclude  this  article  without  assu- 


HEMORRHAGE  FROM  THE  BOWELS. 


515 


ring  you,  that  it  is  especially  in  this  form  of  haemorrhage 
that  the  hsemospastic  remedies  exert  such  a  specific 
influence.    [Consult  Ilamosjjasis.'] 

MELJENA. 

Ecemorrhage  from  (lie  Borcels — This  affection,  I  have 
no  doubt,  is  rare  as  an  original  functional  disease,  though 
I  have  met  with  it  very  frequently  in  this  climate  as  an 
attendant  of  various  organic  affections. 

Discharges  of  dark  blood  from  the  bowels,  (if  you  have 
an  opportunity  of  inspecting  it,)  is  generally  easily  disco- 
vered. You  may  have  some  doubts,  as  it  is  sometimes 
the  result  of  hseinatemesis,  (hemorrhage  from  the 
stomach,)  and  again  you  may  confound  it  with  hsemor- 
rhoidal  flux.  It  is,  therefore,  by  no  means  always 
easy  to  decide,  in  any  particular  case  of  bloody  evacua- 
tions from  the  alimentary  canal,  whether  or  not  intesti- 
nal haemorrhage,  strictly  so  called,  really  exists. 

The  discharges  are  of  various  colors.  It  sometimes 
passes  in  large  quantities,  without  much  alteration; 
when  such  is  the  case  I  am  satisfied  it  is  from  the  bow- 
els. Again  you  will  find  the  discharges  almost  as  black 
as  pitch;  when  such  is  the  case  it  is  questionable 
whether  it  is  haemorrhage  from  the  mucous  membrane 
of  the  bowels,  or  from  the  minuter  ramifications  of  the 
portal  vein  in  the  glandular  texture  of  the  liver.  This 
variety  of  discharges  is  quite  common  with  us.  I  am 
not  prepared  to  give  an  opinion  as  to  the  fact ;  but  a 
distinguished  physician  furnishes  a  very  ingenious  argu- 
ment in  support  of  the  latter.  He  says,  "a  certain 
degree  of  congestion  of  the  liver  will  occasion  an  exces- 
sive secretion  of  vitiated  bile,  constituting  the  common 
autumnal  cholera,  and  the  various  modifications  of 


516 


HEMORRHAGE  FROM  THE  BOWELS. 


bilious  complaints ;  but  that  when  the  congestion  of  the 
liver  occurs  to  a  still  greater  extent,  the  secreting  rami- 
fications of  the  vena  porta  no  longer  eliminate  bile,  but 
pour  forth  a  dark  and  highly  carbonized  blood,  un- 
charged with  secretion;  that  this  dark  fluid  passes 
through  the  minute  biliary  pores,  and  is  conveyed 
through  the  common  excretory  hepatic  ducts,  to  the 
duodenum,  (the  upper  bowel,)  and  is  carried  downwards 
along  the  intestines."  He  conceives,  therefore,  that  this 
disease  differs  but  in  a  degree,  in  the  pathological  condi- 
tion which  occasions  its  symptoms,  from  cholera  and 
other  bilious  disorders. 

To  distinguish  it  from  bleeding  piles,  the  blood  which 
escapes  from  them  is  always  passed  after  an  evacuation, 
and  is  fresh,  of  a  florid  red  color ;  but  in  haemorrhage 
from  the  bowels,  they  are  most  generally  black,  and  the 
blood  is  intimately  mixed  with  the  secretions,  and  farther, 
there  is  considerable  pahi  in  the  bowels  in  this  disease, 
whilst  in  bleeding  piles  it  is  confined  to  the  rectum. 

Symptoms. — In  most  cases  of  intestinal  haemorrhage 
the  early  symptoms  are  not  striking  or  easily  recognized, 
there  may  be  purging  of  blood  in  some  instances  for 
some  time  before  the  patient  is  himself  aware  of  the  fact. 

The  patient  generally  feels  some  uneasiness  before  an 
attack,  such  as  a  sense  of  weight  in  the  lower  portion 
of  the  bowels,  and  they  are  frequently  tender  upon 
pressure ;  the  discharges  are  very  offensive  \  it  is  said 
by  a  distinguished  author  that  the  discharge  of  blood  is 
almost  universally  preceded  by  evidences  of  disease. 
"  Often  this  disease  is  of  a  well  known  and  marked 
character,  as  enteritis,  dysentery,  enteric  fever,  scurvy, 
&c,  of  all  of  which  haemorrhage  from  the  bowels  is  an 
occasional  concomitant ;  you  have  a  furred  tongue,  de- 


HEMORRHAGE  FROM  THE  BOWELS. 


517 


ficient  or  disordered  appetite,  constipation  or  diarrhoea, 
a  pale,  sallow,  or  dingy  complexion,  dejection  of  spirits, 
languor,  weakness,  and  more  or  less  disorder  of  the 
circulation,  indicating  a  derangement  of  health  of  some 
duration,  of  which  visceral  disorder  and  impaired  diges- 
tion are  the  most  prominent.  A  patient  in  this  eond? 
tion  is  unexpectedly  affected  with  griping  pain,  nausea, 
increased  paleness,  and  more  or  less  giddiness,  faintness, 
depression  of  pulse,  and  coolness  of  the  extremities, 
attended  by  a  discharge  from  the  bowels,  which,  on 
examination,  proves  to  be  blood  of  black  color,  very 
offensive,  and  otherwise  altered  in  character;"  this  diar- 
rhoea, frequently,  as  we  have  before  observed,  exists  for 
some  days  with  these  peculiar  symptoms,  without  occa- 
sioning any  anxiety,  until  attention  is  called  to  the 
bloody  nature  of  the  stools.  "  In  some  instances,  again, 
the  haemorrhage  comes  on  without  any  premonitory 
symptoms,  and  the  evacuations  from  the  bowels,  and  its 
attendant  depression,  are  the  first  obvious  signs  of  dis- 
ease. This  depression  is  sometimes  extreme,  and  the 
patient  may  even  sink  beyond  the  point  of  reaction. 
Sudden  prostration  and  death  have  occurred  without 
any  evacuation,  and  the  cause  has  remained  concealed 
until  dissection  has  revealed  a  vast  collection  of  blood, 
fluid  or  coagulated,  in  the  small  intestines. " 

Frequently  these  discharges  are  attended  with  much 
pain,  which,  I  think,  is  an  evidence  of  some  organic 
disease  of  the  intestines,  and  again,  it  is  accompanied 
with  little  or  no  pain,  the  symptoms,  in  many  cases,  are 
very  closely  allied  to  that  of  dysentery,  and  the  disease 
is  quite  common  in  those  localities  where  dysentery  is 
endemic. 

Inflammation  of  the  substance  of  the  liver,  especially 


518 


ILEMORRIIAGE  FROM  THE  BOWELS. 


when  it  is  extensive,  is  frequently  accompanied  with 
haemorrhage,  and  if  the  blood  be  black,  exhibiting  a 
good  deal  of  adhesion  in  its  character,  presenting  at  the 
same  time  both  a  red  and  bilious  appearance,  then  I  am 
satisfied  it  proceeds  from  that  organ,  and  not  from  the 
mucous  membrane  of  the  intestines. 

If  there  is  structural  disease  of  the  liver,  pervading 
that  organ  extensively,  affecting  in  the  least  the  rami- 
fications of  the  vena  porta,  you  are  then  liable  to  have 
haemorrhage  from  the  stomach  or  intestines,  and  very 
probably  from  both.  "In  these  cases  the  blood  dis- 
charged is  dark  and  grumous,  the  stools  presenting  all 
those  characters  which  constitute  fully  this  disease. 
This  form  of  hemorrhage  occurs  frequently  in  persons 
of  broken  down  constitutions,  and  who  have  been  addicted 
to  ardent  spirits."  It  is  frequently  complicated  with 
dropsy  of  the  abdomen,  and  in  such  cases  the  chances 
of  affording  relief  are  very  limited.  You  are  restricted 
with  your  means  to  a  small  compass,  "  and  it  will  re- 
quire the  utmost  skill  of  the  practitioner  to  meet  the 
successive  emergencies  of  the  case." 

It  is  superfluous  to  say  that  the  general  symptoms 
attending  this  disease  are  variable,  from  the  fact  that 
the  number  of  diseases  with  which  it  is  sometimes  con- 
nected, renders  it  almost  impossible  to  embrace  an  accu- 
rate description  of  them. 

Causes. — It  is  peculiarly  important  to  distinguish,  as 
near  as  possible,  the  precise  cause  which  produces  the 
haemorrhage.  No  treatment  will  be  judicious  or  rational 
unless  you  have  a  proper  knowledge  of  the  pathology  of 
the  case.  The  suggestions  we  have  made  in  regard  to 
haemorrhage  from  the  stomach,  are  to  a  great  extent 
applicable  here. 


HAEMORRHAGE  FROM  TnE  BOWELS. 


519 


Direct  irritants,  and  I  think  drastic  cathartics  under 
peculiar  conditions  of  the  system,  have  a  tendency  to 
produce  congestion,  and  whatever  tends  to  produce  irri- 
tation or  inflammation  in  combination  writh  congestion, 
may  occasion  this  variety  of  haemorrhage.  You  will 
frequently  meet  with  this  haemorrhage  as  an  attendant 
on  the  course  of  continued  fevers,  I  regard  it  generally 
in  such  cases,  as  the  result  of  congestion  of  the  mucous 
membrane  of  the  bowels.  In  such  cases,  if  the  dis- 
charge is  abundant,  you  will  have  to  adopt  those  reme- 
dies which  we  have  already  pointed  out  to  control  active 
haemorrhage. 

We  have  alluded  to  it  in  connection  with  a  variety 
of  diseases,  and  it  is  particularly  connected  with 
diseases  of  the  liver  and  spleen,  and  sometimes  attends 
on  solid  tumors,  malignant  ulcerative  affections,  organic 
derangements,  suppression  of  the  menses ;  but  its  most 
common  pathological  condition  is  probably  congestion  of 
the  portal  system,  dependent  on  torpor  or  organic 
disease  of  the  liver,  or  enlargement  of  the  spleen. 
Hence  its  occasional  occurrence  in  protracted  intermit- 
tents  and  association  wuth  abdominal  dropsy.  Enteric 
or  typhoid  fever,  uniting  occasionally  the  two  conditions 
of  a  haemorrhagic  state  of  the  blood,  and  an  inflamed 
and  ulcerated  state  of  the  bowels,  is  liable  to  very 
serious  complication  with  intestinal  haemorrhage,  which 
sometimes  renders  speedily  fatal,  cases  that  might  other- 
wise end  favorably. 

Treatment — In  the  treatment  of  this  affection,  you 
must  have  an  eye  to  the  pathological  state  in  which  it 
was  originated. 

If  the  haemorrhage  is  passive,  and  occurs  as  a  result 
of  scorbutis,  purpura  haemorrhagica  or  small  pox,  you 


520  HEMORRHAGE  FROM  THE  BOWELS. 

will  then  treat  it  with  the  oil  of  turpentine,  20  gtts. 
given  every  six  hours,  and  keep  the  bowels  open  with 
mild  aperients. 

Where  the  haemorrhage  is  vicarious,  resulting  from 
suppressed  catamenial  secretions,  it  may  in  general  be 
removed  by  the  exhibition  of  aloetic  preparations. 

Where  the  haemorrhage  results  from  any  organic 
lesion  which  gives  rise  to  intestinal  haemorrhage,  you 
frequently  find  it  resulting  from  ulceration  of  the 
mucous  membrane,  especially  in  cases  of  dysentery  and 
continued  fever.  This,  under  the  circumstances,  is  a 
formidable  symptom,  and  in  your  treatment,  you  must 
carefully  avoid  all  substances  which  can  prove  the  least 
irritating.  Opium  is  here  your  anchor,  you  may  give  it 
in  large  doses,  and  at  such  intervals  as  will  have  a 
tendency  to  give  perfect  quiet  and  repose  to  the  intes- 
tines, endeavoring  to  control,  if  possible,  the  peristaltic 
motion. 

When  the  haemorrhage  is  the  result  of  inflammation 
of  the  liver,  the  indications  are,  that  the  remedies  that 
will  control  the  hepatitis,  would  at  the  same  time  re- 
lieve the  haemorrhage ;  now  where  we  have  haemorrhage 
as  the  result  of  such  a  variety  of  diseases,  it  naturally 
introduces  the  remedy,  which  heretofore  has  been  almost 
universally  relied  on,  namely,  calomel  ;  and  which  a 
distinguished  author  asserts  is  too  often  indiscriminately 
used ;  he  says,  "  the  extraordinary  and  immediate 
benefit  often  afforded  by  mercury  in  common  affections 
of  the  assimilating  organs,  is  one  of  the  great  sources  of 
its  abuse.  Medical  men  know  they  can  produce  by  its 
means,  a  certain  ofT-hand  effect ;  and  to  save  themselves 
trouble,  and  at  the  same  time  to  gain  the  doubtful  repu- 
tation of  being  decisive  and  quick  in  their  practice, 


HEMORRHAGE  OF  THE  BOWELS. 


521 


they  resort  to  mercury  without  due  regard  to  its  remote 
consequences.  Twenty  or  thirty  years  ago,  this  abuse 
of  mercury  was  carried  to  a  much  greater  extent  than 
it  is  at  present."  A  close  of  calomel  at  night,  followed 
by  a  dose  of  castor  oil  in  the  morning,  and  probably  re- 
peated two  or  three  times,  was  the  only  panacea  for  all 
diseases,  without  regard  to  the  constitution  of  the 
patient.  Although  the  miserable  consequences  of  this 
indiscriminate  use  of  mercury  were  often  too  apparent 
to  escape  notice,  yet  such  was  its  convenience,  and  such 
the  force  of  habit,  that  the  practice  long  maintained  its 
ground.  Nay,  even  yet,  the  abuse  of  mercury  in  this 
country  is  far  from  being  obsolete,  and  it  is  a  fit  subject 
even  now/ for  animadversion. 

The  effect  of  mercury  on  different  constitutions,  and 
in  different  states  of  the  same  constitution,  are  remark- 
ably various.  Some  individuals,  both  in  a  state  of  health 
and  of  disease,  are  almost  insensible  to  the  action  of 
mercury,  while  other  individuals,  under  all  circum- 
stances, are  affected  by  the  minutest  doses.  As  a  gene- 
ral rule,  I  believe  it  is  admitted,  that  a  state  of  health 
is  more  susceptible  of  the  influence  of  mercury  than  a 
state  of  disease,  particularly  of  inflammatory  diseases. 
Hence,  many  individuals  who  would  be  instantly  sali- 
vated by  a  few  grains  of  calomel,  when  in  health,  •  will 
be  often  found  to  bear  almost  any  quantity  of  that  drug 
when  laboring  under  an  acute  inflammatory  attack. 
These  peculiar  and  important  effects  of  mercury  point 
at  once  to  the  following  maxims  regarding  its  use.  Mer- 
cury ought  to  be  cautiously  administered  to  strangers, 
and  to  those  on  whose  constitutions  its  effects  have  not 
yet  been  ascertained. 

Mercury  ought  in  no  instance  to  be  administered  for 


522 


HEMORRHAGE  FROM  THE  BOWELS. 


those  slight  deviations  from  health  which  can  be  readily 
removed  by  safer  expedients. 

The  practical  value  of  these  maxims  may  be  thus 
illustrated : — One  of  the  supposed  effects  of  mercury  is 
its  stimulating  operation  on  the  liver ;  and,  admitting 
this  common  opinion  of  its  action  to  be  well  founded,  let 
us  briefly  inquire  into  the  consequences  of  perpetually 
subjecting  the  liver  and  the  other  assimilating  organs 
to  the  stimulus  of  mercury. 

The  stimulating  effects  of  mercury  may  be  analogi- 
cally illustrated  by  the  stimulating  effects  of  dram-drink- 
ing. As  the  stomach  accustomed  to  ardent  spirits  will 
scarcely  tolerate  any  weaker  beverage,  so  the  liver, 
accustomed  to  the  stimulus  of  mercury,  will  hardly 
respond  to  any  other  influence.  Those,  therefore,  who 
in  early  life  have,  on  all  trivial  occasions  resorted  to  the 
powerful  stimulus  of  mercury,  like  early  dram-drinkers, 
are  usually  obliged  to  persist  in  the  baneful  habit.  The 
truth  of  this  analogy  will  be  scarcely  questioned ;  for, 
the  most  superficial  observer  must  have  noticed  that 
patients  who  habitually  take  calomel  are  more  than 
ordinarily  subject  to  periodical  congestions,  or  biliary 
attacks,  as  they  are  termed;  and  that  such  biliary 
attacks  will  rarely  yield  to  any  other  remedy  than  calo- 
mel. Nor  is  the  insensibility  to  gentler  expedients, 
thus  too  often  produced  in  the  soundest  constitutions  by 
the  use  of  mercury,  its  only  fault ;  the  habitual  use  of 
this  remedy  is  capable  of  exerting  positive  mischief  on 
the  assimilating  functions  and  on  the  kidneys  of  some 
individuals.  This  has  been  demonstrated  in  many 
instances.  Moreover,  those  whose  systems  have  been 
under  the  influence  of  mercury  in  a  degree  not  far  short  of 
salivation,  are  notoriously  liable  to  take  cold,  rheuma- 


HEMORRHAGE  FROM  THE  BOWELS. 


523 


tisnij  &c.,  from  slight  exposure ;  and  various  formidable 
and  fatal  diseases,  as  consumption,  &c,  can  be  often  dis- 
tinctly traced  to  such  exposure  under  the  influence  of 
mercury. 

Many,  I  have  no  doubt,  whose  views  have  been  lim- 
ited to  the  immediate  operation  of  mercury,  will  be  dis- 
posed to  think  that  what  is  here  said  of  its  ulterior 
effects  is  exaggerated.  If,  however,  they  will  take  the 
pains  to  investigate  the  history  of  mercurialized  patients, 
and  particularly  the  condition  of  their  assimilating  organs 
and  kidneys,  they  will  soon  find  ample  proof  of  the 
truth  of  what  has  been  stated ;  at  least  I  can  truly  say, 
that  a  large  proportion  of  the  most  inveterate  dyspeptic 
and  urinary  diseases  which  I  have  seen,  have  been  dis- 
tinctly referable  to  the  abuse  of  mercury.  I  am  pre- 
pared for  the  objection,  that  many  individuals  begin  the 
use  of  mercury  early,  and  continue  it  with  the  same  evi- 
dent advantage  to  extreme  old  age ;  and  I  meet  this 
objection  by  the  statement,  that  many  individuals  begin 
the  free  use  of  wines  and  of  spirits  at  an  early,  and  con- 
tinue to  use  them  to  an  extreme  old  age ;  but  no  one,  for- 
getting the  millions  that  have  hi  the  meantime  fallen 
victims  to  the  abuse  of  fermented  liquors,  will  contend 
that  such  ought  to  become  the  rule;  and  the  same 
rule  is  strictly  applicable  to  the  abuse  of  mercury. 

In  these  observations,  for  myself,  I  wish  to  be  fairly 
understood.  I  am  not  wedded  to  any  theory,  or  so  pre- 
judiced against  any  remedy,  that  I  cannot  render  to 
either  impartial  justice.  If  a  disease  does  exist,  and 
where  I  thought  this  remedy  was  indicated,  especially 
if  there  was  no  peculiar  idiosyncracy  of  constitution  to 
forbid  i^  I  would  not  hesitate  to  administer  it ;  it  is  an 
active  remedy,  entitled  to  consideration.    I  entertain  a 


524 


HEMORRHAGE  FROM  THE  BOWELS. 


high  regard  for  it  in  the  disease  under  consideration, 
but  I  hope  I  use  it  with  judgment  and  discretion. 

My  medical  friends  fully  understand  this  agent,  con- 
sequently my  remarks  are  more  applicable  to  the  gene- 
ral reader ;  and  here  permit  me  to  impress  upon  you  one 
fact,  that  whenever  you  use  mercury,  unless  you  are 
combatting  a  real  disease,  you  are  liable  to  produce 
disease  by  its  administration.  It  is  a  dangerous  remedy 
in  many  diseases,  and  attended  with  the  worst  conse- 
quences in  many  constitutions ;  permit  me  to  warn  you, 
as  an  honest  man,  against  the  indiscriminate  use  of  so 
active  and  powerful  a  remedy. 

As  we  before  remarked,  when  your  haemorrhage  is 
the  result  of  inflammation  of  the  liver,  which  is  some- 
times an  example  of  sympathetic  haemorrhage,  from  the 
fact  that  the  congestion  and  exhalation  from  the  mucous 
membrane  depends  on  this  organ,  and  very  frequently 
the  spleen ;  consequently,  when  the  haemorrhage  is  so 
profuse  as  to  be  alarming,  no  matter  with  what  disease 
it  may  be  associated,  your  first  indication  should  be  to 
arrest  it,  and  for  this  purpose  I  administer  sugar  of  lead 
freely ;  some  advise  kino  and  rhatany  in  combination ; 
this  produces  a  tannate  of  lead,  which  I  apprehend 
would  not  materially  affect  it.  The  infusion  of  roses, 
as  advised  in  menorrhagia,  is  used  here  with  advantage. 
Some  advise  ergot,  with  or  without  opium,  to  arrest  the 
haemorrhage.  If  the  discharges  are  passive,  you  have 
no  remedy  to  equal  spirits  of  turpentine ;  it  should  be 
given  from  five  to  twenty  drops  every  hour  or  two. 

When  you  are  satisfied  that  the  haemorrhage  arises 
from  diseases  of  the  liver,  I  do  not  hesitate  to  recom- 
mend to  you  to  administer  mercury;  here  it  will 
meet  all  of  your  anticipations,  you  will  find  it  the 


HEMORRHAGE  FROM  THE  BOWELS. 


525 


reined}'.  If  tlie  affection  is  merely  functional,  give 
a  grain  of  calomel  every  two  hours,  until  you  administer 
ten  grains,  this  will  generally  control  the  affection ;  if, 
however,  there  is  inflammation  of  the  liver,  you  should 
combine  small  portions  of  opium  and  ipecac,  with  the 
calomel. 

Some  substitute  the  nitro-muriatic  acid  for  the  calo- 
mel. In  some  cases  you  will  derive  much  benefit  by 
cupping  over  the  region  of  the  liver,  and  administering 
castor  oil,  12  or  18  hours  after  you  have  given  the  cal- 
omel. 

In  this  climate  }~ou  will  meet  with  many  cases  of 
enlarged  spleen,  which  are  frequently  accompanied  by 
hemorrhages  from  the  whole  mucous  membrane  of  the 
alimentary  canal.  I  have  given  you  its  pathology  here- 
tofore. When  the  discharge  is  from  the  spleen  it  is 
attended  with  considerable  exhaustion  of  the  vital  pow- 
ers. If  the  strength  of  the  patient  will  admit,  you 
should  cup  him  freely  and  fully  over  the  spleen,  and  the 
free  use  of  purgatives  must  be  resorted  to.  Calomel  is 
not  borne  well  when  haemorrhage  arises  from  the  spleen ; 
it  is  asserted  that  salivation  is  very  easily  induced.  It 
is  not  uncommon  to  observe  purpurous  spots  on  the 
skin,  in  conjunction  with  this  disease  and  enlarged 
spleen,  a  pathological  condition  which  indicates  a  vitia- 
ted state  of  the  blood.  Nevertheless  this  variety  is  not 
so  incurable  nor  so  fatal  as  that  connected  with  diseased 
liver.  There  may  be  cases  in  which,  from  the  activity 
and  strength  of  the  pulse,  it  would  be  necessary  to 
administer  nauseates  and  aconite  or  digitalis,  to  control 
the  circulation.  Cups  and  fomentations  to  the  abdomen 
may  also  be  indicated  in  certain  cases,  and  external 
derivations  are  often  useful. 


526 


DEOPSY  OF  THE  ABDOMEN. 


It  is  frequently  necessary  to  support  the  strength  of 
the  patient  by  nutritious  food,  and  sometimes  even  by 
stimulants.  This  is  especially  the  case  in  the  passive 
forms  of  haemorrhage  attending  low  fevers.  Where 
there  is  nausea,  milk  mixed  with  lime-water  will  be 
found,  on  the  whole,  the  most  suitable  article  of  diet. 
Sometimes  it  will  be  necessary  to  resort  to  animal  broths 
and  jellies.  Should  stimulation  be  advisable,  it  may 
be  most  safely  effected  by  wine-whey.  Care  should 
be  taken  to  allow  no  article  of  food  which  would  be 
likely  to  pass  undissolved  through  the  stomach ;  hence 
liquid  aliment  is  preferable.  Vegetables,  being  generally 
difficult  of  digestion,  should  be  avoided. 

In  convalescence  great  attention  must  be  paid  to  the 
patient.  He  must  avoid  irritants  of  every  character, 
and  keep  still  and  quiet. 


DISEASES  OF  THE  SEROUS  AND  CELLULAR 
TISSUE. 

ASCITES. 

Dropsy  of  the  Abdomen. — By  the  term  ascites,  we 
understand  there  is  a  collection  of  water  in  the  cavity 
of  the  abdomen ;  and  this  form  of  dropsy  is  very  com- 
mon. This  variety  of  dropsy  is  frequently  only  an 
incident  of  general  dropsy;  in  a  large  majority  of  cases, 
however,  it  is  entirely  local.  The  water  is  generally 
collected  in  the  sac  of  the  peritoneum,  (a  serous  mem- 
brane which  lines  the  abdominal  cavity,)  or  general 
cavity  of  the  abdomen,  and  uncombined  with  any  mor- 
bid collection  of  water  elsewhere.    This  is  the  species 


DROPSY  OF  THE  ABDOMEN. 


527 


of  dropsy  to  which  ascites  should  be  strictly  restricted. 
The  collection  is  sometimes  found  without  the  perito- 
neum, and  between  this  and  the  abdominal  contents. 
You  sometimes  find  the  liquid  secreted  ii\  sacs,  and  con- 
nected with  the  peritoneum;  it  is  termed  encysted 
dropsy;  and  there  is  another  variety,  having  all  the 
appearance  of  this  form  of  dropsy,  occurring' in  women, 
resulting  from  disease  of  one  or  both  of  the  ovaries. 

That  form  of  dropsy  which  we  now  propose  to  treat, 
is  nothing  more  or  less  than  an  accumulation  of  serous 
fluid  in  the  bag  of  the  peritoneum. 

This  form  of  dropsy,  generally  commences  in  the 
lower  2)ortions  of  the  abdomen,  and  gradually  extends 
upwards ;  this  keeps  on  increasing  until  the  whole  ab- 
domen becomes  swelled  and  very  much  enlarged.  The 
first  sensation  is  usually  that  of  an  uneasy  fullness  of 
the  abdomen,  accompanied  with  loss  of  appetite,  dryness 
of  the  skin,  a  great  diminution  of  the  discharge  of  urine, 
and  attended  with  costiveness.  The  progressive  en- 
largement of  the  abdomen  is  uniform,  and  while  the 
patient  is  in  an  upright  position,  the  distension  is  per- 
fectly equal  in  the  lower  portion  of  the  abdomen,  but 
whatever  position  he  may  be  in,  you  will  find  a  promi- 
nence of  the  abdomen,  on  the  side  in  which  he  is  lying. 
Where  the  collection  of  water  becomes  great,  it  forces 
the  abdominal  contents  to  press  upon  the  diaphragm 
(vulgarly  called  midriff)  and  excites  coughing. 

Where  there  is  a  copious  collection  of  liquid,  the 
practitioner  may  be  perfectly  sensible  of  it,  if  the  left 
hand  be  laid  flat  against  one  side  of  the  abdomen,  and 
a  slight  blow  be  struck  with  the  other  hand  on  the 
opposite  side ;  the  blow  gives  an  impulse  to  the  collec- 
tion of  water,  which  is  conveyed  by  a  wave  of  the 


528 


DROPSY  OF  THE  ABDOMEN. 


liquid  against  the  hand  which  was  placed  upon  the 
abdomen,  the  sensation  conveyed  to  the. hand  is  very 
perceptible,  and  where  the  amount  of  liquid  accumu- 
lated is  large,  the  more  sensible  and  decided  is  the 
fluctuation. 

When  the  peritoneum  contains  but  a  small  quantity 
of  water,  the  fluctuation  cannot  be  made  sensible  in  this 
way ;  you  can  frequently  arrive  at  the  fact,  by  percuss- 
ing (striking)  with  one  finger  the  most  dependent  part 
of  the  cavity,  while  you  should  make  pressure  with 
another  finger  very  near  the  part  struck ;  by  this  means 
you  may  sometimes  ascertain  the  presence  of  fluid ;  by 
testing  in  this  manner  you  aid  your  diagnosis,  by  the 
sound  yielded,  where  there  is  liquid  collected ;  the  sound 
over  that  region  is  very  flat. 

The  disease  is  attended  by  various  symptoms,  besides 
those  already  enumerated,  belonging  to  this  form  of 
dropsy  in  general,  or  when  it  originates  as  a  result  of 
organic  derangement.  Of  the  former,  the  countenance 
exhibits  a  pale,  and  frequently  a  bloated  appearance ; 
immoderate  thirst ;  the  skin  dry  and  parched ;  the  urine 
much  diminished  in  quantity,  high  colored,  and  most 
frequently  depositing  a  sediment,  with  more  or  less 
general  swelling.  Sometimes  emaciation ;  the  pulse  is 
very  variable. 

Where  it  originates  from  organic  affections,  the  symp- 
toms, of  course,  vary. 

The  collection  of  water  produces  many  functional 
disturbances,  which  we  have  noticed,  such  as  distension 
and  weight ;  difficulty  of  breathing  and  cough ;  nausea 
and  colicky  pains,  frequently  the  result  of  compression 
of  water  on  the  stomach  and  bowels.  As  the  collection 
of  water  increases,  greater  debility  follows ;  the  action 


DROPSY  OF  THE  ABDOMEN. 


529 


of  the  heart  fails,  drowsiness  sometimes  occurs,  and  the 
patient  dies  from  syncope,  (fainting,)  or  with  symptoms 
of  oppressed  brain. 

This  disease  may  possibly  be  confounded,  with  the 
various  forms  of  encysted  dropsy,  pregnancy,  tympanitis, 
and  distended  bladder. 

It  is  possible  sometimes  to  confound  this  disease  with 
pregnancy,  but  in  ordinary  cases  of  this  kind  there  can 
be  no  difficulty.  Many  cases  are  reported  where  distin- 
guished physicians  have  been  deceived.  That  distin- 
guished surgeon,  Sir  Astley  Cooper,  appointed  a  day  for 
the  operation  of  paracentesis  (usually  called  tapping) 
upon  a  lady ;  in  the  meantime  she  was  taken  in  labor 
and  delivered.  In  justice  to  him,  however,  it  is  reported 
that  the  liquor  amnii  was  enormous. 

If  pregnancy  should  be  complicated  with  dropsy,  the 
most  skilful  physician,  with  all  his  care  and  attention, 
will  be  much  embarrassed  in  arriving  at  a  proper  diag- 
nosis ;  frequently,  amongst  the  ignorant,  the  character 
of  the  physician  depends  on  a  correct  diagnosis.  Dr. 
Good  relates  a  case  fully  in  point :  "  if  dropsy  occurs  at 
a  period  of  life  when  the  catamenia  are  on  the  point  of 
naturally  taking  their  leave,  and  where  the  patient  has 
been  married  for  many  years  without  ever  having  been 
impregnated,  it  is  not  always  easy,  from  the  collateral 
signs,  to  distinguish  between  the  two.  A  lady,  under 
these  circumstances  was,  a  few  years  ago,  attended  for 
several  months  by  three  or  four  of  the  most  celebrated 
physicians  of  this  metropolis,  one  of  whom  was  a  prac- 
titioner in  midwifery,  and  concurred  with  the  rest  in 
affirming  that  her  disease  was  an  encysted  tumor  of  the 
abdomen.  She  was,  in  consequence,  put  under  a  very 
active  series  of  different  evacuants ;  a  fresh  plan  being 
34 


530 


DROPSY  OF  THE  ABDOMEN. 


had  recourse  to  as  soon  as  a  preceding  had  failed.  She 
was  successively  purged,  blistered,  salivated,  treated  with 
powerful  diuretics  and  the  warm  bath,  but  equally  to  no 
purpose,  for  the  swelling  still  increased  and  became 
firmer ;  the  face  and  general  form  were  emaciated,  the 
breathing  was  laborious,  the  discharge  of  urine  small, 
and  the  appetite  intractable,  till  at  length  these  threat- 
ening symptoms  were  followed  by  a  succession  of  sud- 
den and  excruciating  pains,  that  the  domestics,  who 
were  not  prepared  for  their  appearance,  now  supposed 
to  be  forerunners  of  a  speedy  dissolution,  but  which  for- 
tunately terminated  before  the  arrival  of  a  single  medi- 
cal attendant,  in  giving  birth  to  an  infant,  that,  like  its 
mother,  had  wonderfully  withstood  the  whole  of  the  pre- 
ceding medical  warfare  without  injury." 

You  should  be  very  particular  in  getting  a  full  history 
of  the  case,  especially  whether  she  has  been  regular  in 
her  catamenial  discharges  or  not,  though  in  dropsy  this 
discharge  is  very  often  absent. 

The  action  of  the  foetal  heart,  by  means  of  the  stet- 
hoscope, is  the  most  reliable.  If  you  still  have  doubts, 
make  an  examination  per  vagina ;  an  experienced 
accoucher  will  have  no  difficulty.  You  should  be  cau- 
tious not  to  give  a  hasty  decision,  without  very  particu- 
lar examination. 

You  will  have  no  difficulty  in  diagnosticating  between 
dropsy  and  tympanitis.  There  is  an  absence  of  fluctua- 
tion, and  the  universal  resonance  (or  sound)  in  the 
latter  affection  are  sufficient  distinctions. 

In  relation  to  the  distended  bladder,  the  history  of  the 
affection,  with  its  attendant  symptoms  will  most  gene- 
rally aid  you  in  distinguishing  this  disease;  where  you 
have  any  doubt  you  should  introduce  the  catheter. 


DROPSY  OF  THE  ABDOMEN. 


531 


Causes. — -'A  collection  of  serous  fluid,  "whether  in  the 
cellular  membrane  or  in  the  cavities  of  the  body,  is 
caused  by  absorption  falling  short  of  exhalation  in  these 
cells  and  cavities."  Like  other  dropsies,  it  arises  in  con- 
sequence of  a  loss  of  balance  between  those  vessels  whose 
office  it  is  to  secrete  the  fluid  that  lubricates  the  perito- 
neum, and  those  that  take  it  up.  Absorption  is  increased, 
although  not  in  proportion  to  the  exhalation.  Some  con- 
tend that  the  cause  of  dropsy  is-  in  the  exhalant  vessels 
which,  they  say,  pour  out  more  serum  or  water  than  the 
absorbents  take  up,  and  thus  collects  and  forms  dropsy. 
If  the  exhalants  secrete  too  much,  the  absorbents  remain- 
ing healthy;  or,  if  on  the  other  hand,  the  exhalants 
remain  healthy,  whilst  the  absorbents  take  up  too  little, 
accumulation  of  serous  fluid  takes  place  under  opposite 
circumstances. 

Dr.  Eliotson  believes  that  dropsy  arises  from  a  struc- 
tural change  in  the  peritoneum  itself,  and  that  it  does 
not  arise  as  is  generally  supposed,  from  a  diseased  liver ; 
the  doctor  goes  on  farther  to  say  that  he  has  made  many 
post  mortem  examinations  of  ascites,  and  that  he  does 
not  recollect  a  case,  in  which  the  liver  was  not  diseased 
in  some  part  or  other.  I  believe  that  visceral  disease 
is  one  of  the  most  common  causes  of  this  complaint, 
the  effusion  in  many  instances,  I  have  no  doubt,  is  owing 
to  a  mechanical  impediment  to  the  abdominal  circulation ; 
as  where  ascites  occurs  in  one  who  has  been  long 
habituated  to  over  indulgence  in  spirituous  potations. 
The  liver  becomes  softened,  indurated,  (hard,)  hyper- 
trophied,  (enlarged,)  or  so  diseased  that  the  blood  of 
the  portal  system  cannot  circulate  freely  through  it ; 
engorgement  of  the  abdominal  venous  system  conse- 
quently supervenes,  and  transudation  or  increased  secre- 


532 


DROPSY  OF  THE  ABDOMEN. 


tion  of  the  more  watery  parts  of  the  blood  takes  place 
into  the  cavity  of  the  peritoneum.  Hepatic  disease  is 
without  doubt,  the  most  frequent  cause  of  this  variety 
of  dropsy ;  whenever  the  liver  is  enlarged  from  chronic 
inflammation  or  other  degeneration,  especially  in  that 
condition  of  the  liver  which  the  French  have  termed 
cirrliose,  and  which  has  been  termed  by  some  anato- 
mists, the  hob-nail  liver ;  scirrhus  and  tubercles  also 
will  produce  it ;  the  first  named,  cirrhosis,  is  one  of  the 
most  frequent  and  fatal  causes ;  others  contend  that 
irregularity  of  circulation  is  likewise  induced  by  the 
enlargement  of  the  spleen,  so  often  observed  as  a  sequel 
of  intermitting  fever,  (those  who  have  practised  in  this 
climate,  cannot  have  failed  in  seeing  this) .  Some  say 
it  is  an  attendant  on  granular  disease  of  the  kidneys, 
under  some  circumstances.  The  spleen  and  mesenteric 
glands  may  act  in  like  manner  with  the  liver,  by 
diminishing  the  capacity  of  the  portal  vein,  or  its 
branches ;  I  mean,  of  course,  when  they  are  enlarged, 
and  under  these  circumstances,  they  may  increase  the 
irritation  of  the  peritoneum. 

Treatment.— This  should  be  conducted  upon  the  same 
principles  of  general  dropsy ;  and  your  first  indications 
should  be  to  evacuate  the  water,  and  prevent  the  reac- 
cumulation  by  restoring  the  tone  of  the  system.  Some 
place  great  reliance  on  the  lancet,  it  is  a  remedy  that  I 
have  never  used,  and  flatter  myself  that  I  enjoy  some 
reputation  in  the  cure  of  dropsy,  from  having  treated 
many  cases  successfully.  If  the  accumulation  of  water 
is  large,  and  the  disease  is  active,  perhaps  the  most  effi- 
cient remedies  for  removing  the  fluid,  are  brisk  cathar- 
tics, diuretics  and  local  revulsives.  You  must  be  care- 
ful in  your  examination,  to  discover  if  possible,  the 


DROPSY  OF  THE  ABDOMEN. 


533 


pathological  cause,  and  if  the  kidneys  are  the  least 
diseased,  you  will  derive  much  benefit  from  diuretics. 

To  fulfil  the  first  indication,  I  generally  resort  to  the 
Hydragogue  cathartics,  (medicines  that  are  capable  of 
expelling  effused  serum  from  any  part  of  the  body,) 
and  for  this  purpose,  I  generally  administer  the  follow- 
ing : 

fy.    Powdered  Gamboge,  Sss. 
Carbonate  of  potash,  Si. 
Brandy,  f.Sxii. 

Mix  the  powders  intimately,  add  the  spirit,  and 
digest  for  four  days  with  a  gentle  heat.  I  give  it  to 
adults  in  doses  from  half  a  drachm  to  a  drachm,  every 
three  or  four  hours,  until  free  purgation  is  produced. 
In  a  large  majority  of  cases,  you  will  find  the  liver 
torpid,  and  frequently  the  dropsy  is  the  result  of  chronic 
inflammation  of  that  organ ;  in  this  variety,  you  will 
experience  much  benefit  from  the  compound  pill  of 
podophyllin  : 

^.    Podophyllin,  (active  principle  of  mandrake). 
Scammony,    (Syrian  birdweed). 
Gamboge,     aa.  5i. 

These  ingredients  should  be  triturated  well  for  half 
an  hour,  then  add 

Castile  soap,  Bss. 

Mix,  and  divide  into  120  pills.  You  should  give  two 
pills  every  night ;  it  is  a  valuable  purgative,  producing 
no  nausea,  griping  or  debility. 

Some  advise,  that  whatever  remedy  is  employed  for 
the  evacuation  of  the  serum,  it  is  very  often  essential  to 
conjoin  with  it  the  use  of  mercury.    The  mercurial, 


534 


DROPSY  OF  TEE  ABDOMEN. 


under  all  circumstances,  if  resorted  to,  should  be  cau- 
tiously employed ;  where  the  collection  of  fluid  depends 
upon  visceral  obstructions,  I  have  frequently  derived 
benefit  from  the  following : 

1^.    Pulveris  digitalis,  grs.  xii.  (fox  glove.) 

Hydrg.  chloridi  mitis,      grs.  iv.  (calomel.) 
Pulv.  opii,  grs.  iv. 

Confection  of  roses,  q.  s. 

Make  into  twelve  pills,  give  one  every  six*  or  eight 
hours. 

For  the  purpose  of  lessening  the  swelling  and  tension 
of  the  abdomen,  many  advise  the  compound  powder  of 
jalap,  or  the  following : 

fy.    Spirea  ulmaria,       gi.  (queen  of  meadow.) 
Asclepias  syriaca,    gii.  (milk  weed.) 
Bace.  Junip.,  gii.  (juniper  berries.) 

Kaph.  rusticanus,     Bi.  (horse-radish.) 
Sinapis  alba,  gss.  (mustard  seed.) 

Xanthox.  fraxin,      £ii.  (prickly  ash  bark.) 
Bruise  all  separately,  and  then  mix.    To  the  powder 
add  one  gallon  of  good  cider.    Give  wine-glassful  four 
or  five  times  a  day. 

Elaterium  is  a  good  remedy,  and  frequently  better 
than  almost  any  other  in  expelling  the  fluids,  the 
patient  will  bear  up  under  it  for  a  considerable  time 
if  administered  every  other  day ;  you  should  commence 
with  it  in  small  doses,  increasing  gradually  up  to  one 
and  a  half  or  two  grains  a  day.  You  must  be  very 
particular  in  noticing  the  effects  of  hydragogue  cathar- 
tics, as  frequently  the  debilitating  effects  of  those  active 
cathartics  cannot  be  borne ;  under  these  circumstances 


DROPSY  OF  THE  ABDOMEN.  535 

you  should  resort  to  diuretics,  and  for  this  purpose  I 
generally  administer  the  following : 

fy.    Cortex  sambucus,  1  lb.  green,  i  lb.  dry,  (elder  bark.) 
Lisbon  wine,  1  gallon. 
Simmer  about  an  hour,  strain  and  bottle.   Give  wine- 
glassful  three  times  a  day. 

You  will  also  generally  find  that  the  bitartrate  of 
potassa  answers  a  good  purpose. 

As  a  diuretic  the  following  is  recommended  by  a  dis- 
tinguished eclectic  practitioner :  Take  queen  of  the 
meadow  roots,  dwarf  elder  bark,  marsh  mallow  roots, 
mountain  pink,  of  each,  coarsely  bruised,  half  an  ounce, 
place  them  in  one  pint  of  boiling  water  and  one  pint  of 
good  Holland  gin,  and  steep  them  in  a  close  covered 
vessel  for  four  hours,  then  strain,  and  sweeten  well  with 
honey.  In  severe  cases  a  wine-glassful  may  be  given 
every  hour  until  relief  is  obtained,  after  which  every 
three  or  four  hours. 

Where  you  have  succeeded  in  evacuating  the  water 
from  the  abdomen,  to  prevent  its  re-accumulation  you 
will  derive  much  benefit  by  giving  ten  grains  of  capsicum, 
morning,  noon  and  night,  and  continuing  in  small  doses 
and  at  long  intervals  your  diuretic  preparation.  It  is 
not  only  a  useful  but  good  plan  after  the  fluid  is  evacu- 
ated, to  bandage  the  abdomen  well.  Some  recommend 
a  thin  belt  which  will  produce  a  uniform  pressure 
throughout,  it  is  of  great  advantage. 

Where  the  liver  is  not  performing  its  functions,  some 
advise  frictions  with  iodine  ointment,  daily,  or  twice  a 
day,  over  the  region  of  that  organ;  I  think  I  have 
derived  in  some  cases  slight  benefit  from  this  application. 
Where  there  are  any  symptoms  of  inflammation,  many 


536 


DROPSY  OF  THE  ABDOMEN. 


advise  cupping  and  blistering  to  the  abdomen,  either  of 
which,  if  resorted  to,  should  be  used  with  great  caution. 

If  there  is  organic  disease  of  any  sort  I  am  satisfied 
you  will  derive  but  little  if  any  benefit  from  mercury 
and  iodine;  and  as  a  dernier  resort,  you  will  be 
obliged  to  tap  the  patient ;  I  am  rather  an  advocate  of 
tapping  early,  only,  however,  when  you  are  absolutely 
satisfied  you  must  resort  to  it,  after  the  failure  of  purga- 
tives, diuretics,  compression,  &c.  The  mere  fact  of  tap- 
ping will  frequently  be  of  great  use  in  preventing  the 
parts  from  becoming  so  stretched  that  they  will  not 
contract  again. 

Tapping,  says  a  distinguished  author,  has  been 
much  employed,  and  various  opinions  have  been  ex- 
pressed of  its  advantages.  While  some  allow  it  only 
as  a  last  resort,  merely  to  obtain  temporary  relief 
when  all  ordinary  means  have  failed,  others  have  re- 
commended it  as  a  remedy,  capable,  in  some  instances, 
of  effecting  cures.  There  can  be  no  doubt  that  perma- 
nent cures  have,  in  some  rare  cases,  followed  this  opera- 
tion; and  the  opinion  held  by  some,  that  by  removing 
pressure  from  the  kidneys,  it  favors  the  action  of  diure- 
tics, is  probably  not  entirely  without  foundation.  Never- 
theless it  very  generally  fails  to  do  more  than  yield 
temporary  relief,  and  the  liquid  accumulates  again  often 
even  more  rapidly  than  before,  so  as  to  render  a  frequent 
resort  to  the  operation  necessary.  The  quantity  of 
serum  which  has  been  drawn  off,  and  the  number  of 
times  that  tapping  has  been  repeated  in  some  instances, 
are  astonishing.  A  physician  of  Missouri  records  a  case 
in  which  the  operation  was  performed  ninety-six  times 
in  the  course  of  a  few  years,  and  the  whole  amount 
drawn  off  was  two  hundred  and  seventy-five  gallons 


DROPSY  OF  THE  ABDOMEN. 


537 


and  a  half ;  and  a  case  was  reported  by  M.  Lecanu  to 
the  Paris  Royal  Academy  of  Medicine,  in  which  a  woman 
was  tapped  eight  hundred  and  sixty-six  times,  and  ulti- 
mately recovered  under  compression  of  the  abdomen. 
(Dunglison's  notes  to  Encyclopcedia  of  Practical  Medi- 
cine.) 

On  the  whole,  as  I  have  before  observed,  it  should  be 
resorted  to  only  when  it  is  absolutely  necessary ;  and  in 
the  performance  of  the  operation  it  is  highly  important, 
as  the  fluid  escapes,  to  make  compression  of  the  abdomen 
by  means  of  a  bandage,  so  as  to  supply  artificially  the 
pressure  of  the  viscera,  to  which  the  patient  has  been  so 
long  habituated,  and  the  sudden  withdrawing  of  which 
has  repeatedly  proved  fatal,  when  this  precaution  has 
been  neglected. 

You  must  exercise  great  precaution  in  tapping ;  as  to 
the  part  to  be  selected  for  the  purpose,  and  the  mode  of 
operating.  I  would  advise  the  point  that  is  usually 
chosen,  in  the#linea  alba,  a  little  below  the  umbilicus, 
(navel,)  the  bladder  being  previously  emptied.  You 
should  be  careful  to  ascertain  whether  the  disease  really 
exists ;  there  must  not  only  be  fluctuation,  but  fluctua- 
tion evident  from  a  collection  of  fluid.  You  recollect 
that  the  bladder  sometimes  becomes  much  distended, 
and  it  is  sometimes  accompanied  with  pregnancy. 

The  caincae  radix,  (cainca  root,)  where  it  can  be  pro- 
cured pure,  enjoys  much  reputation  in  this  species  of 
dropsy.  The  decoction  is  the  best  form  for  its  adminis- 
tration. 

3^.    Caincae  root,  gii. 
Aqua3,  Oiss. 
Boil  it  down  until  you  make  a  strong  decoction,  and 
give  a  table-spoonful  three  times  a  day. 


538 


DROPSY  OF  THE  ABDOMEN. 


In  those  cases  that  require  the  aid  of  a  tonic  to  keep 
up  the  strength  of  the  patient,  and  to  create  an  appetite, 
we  know  of  nothing  equal  to  the  compound  infusion  of 
peruvian  bark  and  iron.    Use  the  following  recipe : 

ty.    Peruvian  bark,  in  coarse  powder,  §i. 
Sliced  Colombo  root,  oiii. 
Bruized  cloves,  3ii. 
Iron  filings,  Sss. 
Digest  for  three  days  in  a  close  vessel,  add  peppermint 
water  sufficient  to  yield  a  mixture  of  12  ounces  in  filter- 
ing, then  add — 

Compound  tincture  of  cardamon,  giii. 
Tincture  of  orange  peel,  Siii. 
Dose.    One  to  two  fluid  ounces. 

The  following  diuretic  mixture  is  highly  extolled  in 
this  variety  of  dropsy,  namely : 

^5.    Extract  of  dandelion,  3s£ 
Decoction  of  dandelion,  fl.3ix. 
Spirits  of  nitric  ether,  fl.3i. 
Syrup  of  ginger,  3ii. 
Mix.    This  amount  to  be  taken  three  times  a  day. 

Diet — In  almost  every  variety  of  dropsy  a  stimula- 
ting diet  is  indicated ;  and  those  articles  that  are  pecu- 
liarly pungent  in  their  character  should  be  freely 
indulged  in  and  used  with  the  food,  such  as  horse- 
radish, cayenne  pepper,  mustard,  &c. 

I  have  treated  numerous  cases  of  ascites.  You  will 
have  no  need  to  'put  into  requisition  all  the  remedies  I 
have  laid  down ;  by  following  the  directions  you  will  be 
apt  to  afford  relief;  if  you  should  fail,  you  will  find 


DROPSY  OF  THE  HEAD. 


539 


there  is  an  organic  affection  of  some  of  the  organs  impli- 
cated in  the  disease.  [See  cellular  dropsy,  two  last  par- 
agraphs.] 

HYDROCEPHALUS. 

Dropsy  of  the  Head. — Hydrocephalus,  at  the  present 
time,  is  limited  to  effusion  occurring  within  the  cavity 
of  the  skull.  Some  authors,  in  fact  most  of  them, 
speak  of  acute  hydrocephalus,  and  I  question  whether 
there  is  such  an  affection  as  proper  acute  hydrocepha- 
lus, in  the  sense  in  which  the  word  is  generally  used. 
There  is  sometimes  inflammation  of  the  brain,  causing, 
very  frequently,  great  effusion,  and  it  is  from  this  fact 
that  some  authors  speak  of  acute  hydrocephalus. 

It  is  a  disease  that  seems  to  be  almost  peculiar  to 
children ;  and  we  sometimes  find  it  in  adults  who  have 
had  inflammation  of  the  brain ;  it  is  frequently  attended 
with  copious  effusion. 

It  generally  occurs  in  infants  before  the  closing  of  the 
fontanelles ;  but,  as  I  before  observed,  it  may  happen  at 
any  period  of  life,  rarely  known,  however,  beyond  the 
age  of  twelve  or  fourteen.  It  is  a  disease  which  is  fre- 
quently observed  to  pervade  a  family,  affecting  the  major 
portion  of  the  children  at  a  certain  period.  "  Yet,  in  rela- 
tion to  cases  in  which  the  cranium  is  incapable  of 
expansion,  there  must  always  be  some  doubt,  as  the  only 
certain  criterion  of  the  presence  of  water  is  the  increased 
size  4>f  the  head.  Various  organic  diseases  of  the  brain, 
of  a  chronic  character,  are  capable  of  producing  symp- 
toms closely  analogous  to  those  of  hydrocephalus ;  and 
any  diagnosis  that  may  be  formed  in*such  cases  must  be 
more  or  less  conjectural.    All  that  can  be  said  with  pro- 


540 


DROPSY  OF  THE  HEAD. 


priety  is,  that  where  a  case  exhibits  the  ordinary  hydro- 
cephalic signs,  with  the  single  exception  of  the  expanded 
cranium,  after  the  complete  union  of  the  bones  of  the 
head,  there  may  probably  be  dropsy  of  the  brain."  The 
swelling  or  enlargement  of  the  head  is  sometimes  enor- 
mous, widely  separating  the  bones  of  the  head,  and  some- 
times causing  absorption  of  the  brain. 

Causes. — As  I  have  already  observed,  it  is  for  the  most 
part  an  infantile  disease,  chiefly  affecting  children  from 
two  to  fourteen  years  of  age.  It  is  an  affection  that 
runs  in  families.  I  have  known  it  to  succeed  whooping 
cough,  and  frequently  it  occurs  during  teething.  The 
dropsy  of  the  head  is  most  probably,  in  many  instances, 
the  result  of  congestion,  produced  from  slight  inflamma- 
tion of  the  brain,  and  in  some  cases  it  may  arise  from 
general  debility. 

An  author  of  some  ability  says,  a  morbid  state  of  the 
stomach  and  bowels  has  been  supposed  by  some  to  be 
a  predisposing  cause ;  but  of  all  the  causes  which  con- 
tribute to  the  production  of  this  disease,  cold  plays  the 
most  conspicuous  part. 

Symptoms. — Your  attention  seems  directed  to  the  head 
intuitively,  as  the  seat  of  the  disease,  and  one  of  the 
most  striking  phenomena  of  the  disease  is  the  gradual 
enlargement  of  the  same.  The  promonitory  symptoms 
in  children,  are  heaviness  of  the  head,  dullness  of  the 
mind,  headache,  sometimes  referred  to  a  particular  spot 
and  sometimes  diffused.  There  is,  also,  a  peculiar  knit- 
ting  of  the  brows,  impatience,  a  flushed  countenance, 
preternatural  redness  of  the  eyes,  contracted  pupil ;  the 
body  is  hot,  denoting  symptoms  of  infantile  fever,  and 
also  acute  inflammatory  action  of  the  vessels  of  the  brain. 

As  the  disease  progresses,  the  pulse,  before  quick, 


DROPSY  OF  THE  HEAD. 


541 


becomes  slow,  intermitting  or  irregular.  The  stomach 
and  bowels  are  disturbed,  the  tongue  is  white,  yellow,  or 
brown ;  the  pupils  are  permanently  dilated,  and  cease  to 
contract  on  the  approach  of  light.  The  child  frequently 
wakes  screaming,  and  is  very  restless,  both  up  and  in 
bed.  These  symptoms  may  last  only  a  day  or  two,  and 
then  come  on  with  increased  severity,  or  they  may  last 
many  weeks. 

Dr.  Yeats,  who  has  written  upon  "  water  on  the  brain," 
has  made  the  earlier  stages  of  this  disease  his  particular 
study.  He  places  among  the  premonitory  symptoms 
occasionally  present,  tenderness  in  the  scalp,  stiffness  of 
the  neck,  increased  sensibility  of  the  eye  to  light,  and, 
in  some  rare  cases,  severe  earache. 

Dr.  Cheyne  has  directed  the  attention  of  the  profes- 
sion to  the  derangement  in  the  functions  of  the  liver  and 
bowels,  which,  he  says,  so  often  precedes,  and  not  unfre- 
quently  seems  to  excite  this  affection  of  the  brain.  We 
are  aware  of  the  intimate  sympathy  which  exists  between 
the  brain  and  liver,  and  also,  between  the  brain,  stomach, 
and  intestines.  When  we  consider  the  close  and  un- 
questionable sympathy  which  subsists  between  the  head 
and  these  organs,  and  take  along  with  this  the  greater 
exposure  of  the  latter  to  irritating  causes  and  consequent 
functional  derangement,  we  are  disposed  to  think  that 
the  now  very  generally  received  opinion,  as  to  the  fre- 
quent origin  of  hydrocephalus,  in  disorders  of  these 
organs,  is  well  founded. 

The  head  gradually  enlarges,  and  the  expansion  takes 
place  usually  in  all  parts  of  the  bony  case  of  the  brain, 
except  the  base ;  but  it  is  generally  most  conspicuous 
in  the  frontal,  parietal  (sides  of  the  head)  and  occipital 
regions  (base  of  the  head)  ;  the  top  of  the  head  being 


542 


DROPSY  OF  THE  HEAD. 


comparatively  little  affected.  As  the  face  is  in  general 
not  larger  than  usual  in  health,  the  forehead  and  sides 
of  the  cranium  are  made  to  project  very  much,  and 
give  to  the  child  a  peculiar  aspect.  In  some  instances, 
it  is  said  that  the  face  undergoes  a  corresponding  de- 
velopment, and  the  whole  head  appears  gigantic.  The 
enlargement  is  sometimes  irregular,  affecting  especially 
the  forehead,  or  the  parietal  region,  and  being  much 
greater  on  one  side  than  the  other,  so  as  to  occasion 
great  deformity.  The  sutures  of  the  head  not  unfre- 
quently  open,  and  the  bones  of  the  cranium  seem  in 
extreme  cases,  to  be  almost  floating  upon  a  surface  of  , 
liquid.  It  is  said  that  in  some  cases  in  which  the 
collection  of  water  is  very  great,  the  head  appears  some- 
what translucent,  if  placed  between  the  eye  and  the 
light. 

Stages. — When  the  disease  is  well  formed,  some  divide 
it  into  two  stages,  others  contend  for  three.  It  may  and 
frequently  does  occur  without  any  of  the  premonitory 
symptoms.  I  recapitulate  briefly,  the  symptoms  of  the 
different  stages. 

First  Stage. — Pain  in  the  head,  redness  of  the  eyes, 
intolerance  of  light  and  sound,  contracted  pupil,  great 
restlessness,  symptoms  of  infantile  fever,  some  contend 
that  the  pulse  is  rapid  and  full,  others  assert  that  it  is 
slow,  unequal  and  intermitting.  Dr.  Golis,  who  has 
written  a  treatise  on  hydrocephalus,  says  the  abdomen 
sinks,  and  becomes  flatter,  and  that  this  is  a  pathogno- 
monic sign  of  the  disease,  (a  characteristic  symptom  of 
a  disease,)  so  that  if  this  occur,  we  may  be  certain  as  to 
the  nature  of  the  disease ;  there  is  also  costiveness,  the 
discharges  resembling  tar ;  these  symptoms  may  extend 
to  the  seventh  day.    After  this,  you  have  the 


DROPSY  OF  THE  HEAD. 


543 


Second  Stage. — Which  is  that  of  exhaustion;  you 
have  more  or  less  blindness ;  the  pupils  no  longer  con- 
tracted, but  dilated ;  general  insensibility,  almost  a 
complete  state  of  stupor ;  convulsions  or  partial  paraly- 
sis occur ;  the  pulse  is  quick,  and  during  the  apoplectic 
state,  the  pulse  is  rapid,  sometimes  very  rapid. 

Third  Stage. — This  stage,  I  believe,  does  not  occur 
very  frequently.  There  will  appear  to  be  some  sensi- 
bility of  the  eyes  and  ears ;  the  muscular  power,  and  like- 
wise the  mind,  will  be  partially  restored.  Sometimes 
the  stupor  will  pass  off,  and  the  child  will  be  perfectly 
conscious.  Dr.  GoliS  says  these  symptoms  are  always 
accompanied  with  a  very  rapid  pulse,  and  for  the  most 
part,  whatever  restoration  there  may  be,  there  is 
observed  more  or  less  stupor,  and  perhaps  convulsive 
actions. 

Diagnosis. — When  the  disease  is  attended  by  expan- 
sion of  the  head,  you  will  experience  little  difficulty, 
you  must  however  be  careful,  as  you  might  confound  it 
with  a  large  head,  as  the  bones  sometimes  become 
spongy  from  rachitis.  Hypertrophy  (or  enlargement) 
of  the  brain,  wull  also  produce  increased  dimensions  of 
the  cranium.  These  affections  are  so  rare  that  you  will 
seldom  meet  with  any  difficulty. 

Treatment. — I  have  before  remarked  that  the  pre- 
monitory symptoms  may  pass  off  spontaneously ;  and 
if  we  attend  in  removing  them,  most  frequently  nothing 
will  follow.  Consequently,  whenever  you  see  such 
symptoms  as  I  described  in  the  premonitory  stage,  you 
may  expect  hydrocephalus  to  follow ;  it  is  consequently 
your  duty  to  attempt  to  remove  them.  This  may 
generally  be  accomplished ;  but  if  we  fail,  and  hydroce- 
phalus does  come  on,  we  have  at  any  rate,  clone  our 


544 


DROPSY  OF  THE  HEAD. 


duty.  Consequently,  your  first  indication  of  cure,  is 
to  attempt  to  prevent  serous  effusion,  reduce  any  in- 
flammatory action  that  may  be  prevailing,  and  to 
equalize  the  circulation. 

This  is  a  very  difficult  disease  to  remove,  but  prompt 
and  suitable  measures  will  sometimes  afford  complete 
relief.  If  there  has  been  an  effusion  of  fluid,  you 
should  attempt  to  evacuate  it,  by  stimulating  the  ab- 
sorbent vessels. 

In  the  commencement  of  your  treatment,  you  should 
bathe  the  patient  well,  and  the  extremities  frequently 
in  strong  ley  water,  and  your  principal  reliance  must 
be  placed  upon  cathartics,  that  have  a  tendency  to  pro- 
duce copious  fluid  discharges ;  in  the  selection  of  them, 
you  must  have  an  eye  to  his  physical  condition  and 
constitution.  Either  of  the  following  remedies  will  pro- 
duce abundant  secretion  from  the  bowels  : — 
ty.    Senna,  2  lb. 

Jalap,  i  lb. 

Cloves  or  ginger,  5i. 

Pulverize  all  well.  You  can  give  it  to  children  in 
four  to  six  grain  doses,  in  sweetened  water.  Some  ad- 
vise a  grain  or  two  of  cayenne  pepper  to  the  dose.  Or, 
take 

ty.  Equal  parts  of  the  first  prescription,  and  cream 
of  tartar.  Give  to  children  in  ten  grain  doses,  admin- 
istered the  same  way. 

The  following  is  a  recipe  that  is  extolled  by  Dr.  Hill, 
in  strong  terms,  in  every  variety  of  dropsical  affections ; 
it  is  a  valuable  remedy. 

3$j.    Senna  and  manna,  (bruised)        aa.  Bss. 
Pulv.  anise  or  fennel  seeds, 
Epsom  salts  or  cream  of  tartar,    aa.  Zii. 


DROPSY  OF  THE  HEAD. 


545 


Add  1  i  pints  of  boiling  water,  and  simmer  it  slowly 
down  to  one  pint ;  strain  and  sweeten.  Dose  for  chil- 
dren one-third  of  a  tea-spoonful  every  half  hour  until  it 
operates  freely. 

Either  of  the  following  may  be  relied  upon  with  cer- 
tainty : — 

Ify.    Podophyllin,  grs.  ii. 

.  Cream  of  tartar, 

If  you  wish  to  make  your  cathartic  stimulating,  add 
ten  grains  of  cayenne  pepper.  For  childen,  divide  into 
thirty  doses,  and  give  one  every  two  hours. 


Some  prefer — 

fy.    Podophyllin,  grs.  ii. 

Leptandrin,  grs.  viii. 

Loaf  sugar,  9i. 


Mix  thoroughly  in  a  mortar.  Give  in  doses  as  advised 
in  podophyllin  and  cream  of  tartar. 

You  will  find  your  patient  will  generally  have  a  very 
dry  and  constricted  state  of  the  skin,  and  you  will  ex- 
perience much  difficulty  in  inducing  perspiration,  which 
you  must  accomplish,  if  possible.  For  this  purpose,  I 
advise  the  sudorific  tincture,  which  should  be  taken  in 
spearmint  tea.  The  following  is  the  sudorific  prepara- 
tion which  I  esteem  most  highly.  Take, 

^.    Virginia  snake  root,  in  powder, 
Pulv.  Ipecac, 
  Saffron, 

  Camphor,  aa.  5ii. 

Opium,  Sri-,  or  lady  slipper  root,  Sviii. 
Holland  gin,  6  pints. 

Macerate  for  two  weeks,  strain  and  filter  through 
35 


546 


DROPSY  OF  THE  HEAD. 


paper.  You  may  give  this  to  children  in  five  drop 
doses,  in  spearmint  tea,  repeated  at  least  every  hour. 
If  this  recipe,  should  be  too  stimulating,  and  have  a  ten- 
dency to  increase  the  arterial  excitement,  I  then  substi- 
tute the  following  diaphoretic  powder.  Take, 

Opium,  3ss.,  or  cypripedium,  £i. 
Pulv.  camphor,  <  3ii. 

  Ipecac,  3i. 

Cream  of  tartar,  or  bicarbonate  of  soda,  Si. 

Mix  well.  Give  children  ss.  to  1  gr.  every  two  or 
three  hours. 

You  will  find  great  heat  of  the  head,  generally  accom- 
panying hydrocephalus,  and  I  generally  use  cooling 
lotions  externally,  composed  of  equal  parts  of  spirits, 
water  and  vinegar,  to  which  add  a  small  portion  of  table 
salt. 

Most  authorities  advise  calomel  and  the  lancet,  but 
with  what  propriety  I  am  unable  to  determine ;  I  am 
satisfied  that  either  would  have  a  tendency  to  increase 
the  irritation,  and  do  more  harm  than  good. 

Some  advise,  and  I  think  correctly,  that  when  the 
child  exhibits  signs  of  scrofulous  diathesis,  or  is  wasting 
away,  the  preparations  of  iron,  iodine,  or  the  decoction 
of  pipsissewa  (winter  green)  may  be  used,  and  I  have 
no  doubt  with  advantage. 

The  following  is  the  plan  employed  by  Golis,  who  has 
written  extensively  on  hydrocephalus,  and  for  which  he 
claims  great  success. 

The  head  is  to  be  -kept  constantly  covered  with  a 
woolen  cap,  and  every  night  one  or  two  scruples  of  mer- 
curial ointment,  mixed  with  an  ointment  made  from 
juniper  berries,  are  to  be  rubbed  on  the  scalp.  Cal- 


DROPSY  OF  THE  HEAD.  547 

omel  is  to  be  given  in  doses  of  one-quarter  or  one-half  of 
a  grain  twice  a  day,  care  being  taken  that  too  much 
purging  is  not  produced.  For  young  infants,  the  best 
diet  is  mother's  milk,  or  that  of  a  healthy  nurse ;  for 
older  children,  meats,  eggs,  and  coffee  made  from  roasted 
acorns.  Fat  substances,  and  all  alcoholic  liquids  are  to 
be  excluded.  In  pleasant  weather  the  child  should  be 
as  much  as  possible  in  the  open  air ;  in  winter,  the  tem- 
perature of  the  chamber  should  be  about  80°  or  70°  F., 
and  the  child  should  lie  on  a  mattrass,  and  be  carefully 
guarded  against  currents  of  air.  Golis  asserts  that  this 
plan,  duly  persevered  in,  has  produced  complete  and 
lasting  cures  in  many  instances.  Should  no  improve- 
ment be  perceived  at  the  end  of  two  months,  he  advises 
the  use  of  diuretics,  such  as  acetate  of  potassa  and 
squill,  in  connexion  with  the  former  medicines,  and  the 
insertion  of  an  issue  in  the  neck  and  arm,  which  is  to 
be  kept  discharging  for  several  months.  Should  inflam- 
matory symptoms  intervene,  the  antiphlogistic  treat- 
ment is  to  be  employed.  After  the  commencement  of 
recovery,  advantage  sometimes  accrues  from  small  doses 
of  quinia. 

The  great  object,  as  we  before  observed,  is  to  control 
any  inflammation  that  may  exist,  and  to  promote 
absorption  of  the  fluids.  Some  recommend  for  this  pur- 
pose elaterium,  by  putting  a  grain  into  two  ounces  of 
fluid,  and  give  a  child  a  tea-spoonful  of  the  mixture 
every  now  and  then.  Others  extol  highly  the  employ- 
ment of  digitalis  and  squills.  Dr.  Beach  advises  to  take 
a  half  tea-spoonful  of  the  dry  herb,  and  place  it  in  one 
gill  of  boiling  water,  let  it  stand  until  it  becomes  cold. 
Give  a  tea-spoonful  every  two  hours,  to  a  child,  in  a 
table-spoonful  of  parsley  tea. 


548 


DROPSY  OF  THE  HEAD. 


Cupping  is  highly  spoken  of  in  this  disease.  I  have 
never  tried  it.  It  might  be  resorted  to  when  other 
means  have  failed. 

Dr.  Yere  advises,  with  much  confidence,  a  strong  tea 
of  milk-weed,  given  in  doses  as  much  as  the  stomach 
will  bear,  and  use  the  following  fomentation  to  the  head : 
Take  of  wrormwood,  2  oz.;  mullein  and  hops,  2  oz.  each; 
stramonium,  (Jamestown  weed,)  1  oz. ;  mix,  and  add 
water  and  vinegar ;  after  which  the  saline  wash,  with 
the  addition  of  tincture  of  stramonium,  was  freely  used 
four  or  five  times  a  day.  He  advises,  also,  when  there 
is  the  least  fever,  to  bathe  the  child  in  ley  water,  and 
apply  sinapisms  of  garlic  to  the  feet ;  the  latter  always 
when  there  was  pain  in  the  head. 

Dr.  Watson  relates  the  following  mode  of  cure  as 
having  been  effectual  in  a  few  cases.  We  question  the 
propriety  of  mercury  being  beneficial;  it  is  the  high 
standing,  alone,  of  Dr.  Watson  that  prompts  us  to  give 
his  treatment.  He  takes  ten  grains  of  metallic  mercury, 
rubbed  down  with  conserve  of  roses ;  five  grains  of  fresh 
squills  are  added,  and  the  whole  made  into  pills  with 
powdered  liquorice  root.  This  quantity  was  taken  three 
times  a  day  for  nearly  three  weeks.  It  acted  power- 
fully as  a  diuretic,  without  salivation,  but  with  great 
reduction  of  strength  and  flesh,  and  gradual  relief  to  the 
symptoms.  It  was  continued  for  two  weeks  longer,  at 
first  twice,  and  afterwards  once  daily,  at  the  end  of 
which  time  the  cure  was  complete.  The  strength  was 
restored  by  the  use  of  iron ;  and  the  cure  was  perma- 
nent. We  are  under  the  impression  that  compression 
is  a  valuable  agent  in  the  treatment  of  this  disease ;  but 
it  should  be  carefully  made  to  compensate  in  some 
degree,  at  least,  for  the  pressure  that  has  been  removed 


DROPSY  OF  THE  HEAD. 


549 


with  the  fluid.  "We  advise  Barnard's  method,  which  is 
"  to  apply  strips  of  adhesive  plaster,  about  three  quar- 
ters of  an  inch  wide,  completely  round  the  head,  from 
before  backwards ;  then  to  carry  cross  strips  from  one 
side  of  the  head  to  the  other  over  the  crown ;  and  lastly, 
one  long  strip  from  the  root  of  the  nose  over  the  vertex 
to  the  nape  of  the  neck.  This  plan  is  applicable  only 
in  cases  in  which  the  bones  are  loose,  and  the  general 
powers  feeble,  as  shown  by  paleness  of  the  surface,  flab- 
biness  of  the  muscles,  &c.  Should  the  symptoms  be 
aggravated  by  pressure,  it  should  be  relaxed  or  aban- 
doned. 

In  the  latter  or  third  staire  of  the  disease,  I  advise  the 
administration  of  opium,  not,  however,  with  any  idea  of 
its  curative  effects  in  this  disease,  but  simply  to  produce 
sleep  and  tranquility.  I  have  never  seen  any  ill  effects 
follow  its  use. 

The  following  ointment  is  extolled  in  hydrocephalus : 
I$f.    Iodide  of  potassum,       3  parts. 
Iodide  of  mercury,        2  parts. 
Camphor,  2  parts. 

Cerate,  32  parts. 

Mix.  Used  as  an  ointment  to  the  head  in  hydro- 
cephalus, in  doses  of  a  half  drachm  to  a  drachm.  The 
following  preparation  of  fox  glove  has  many  advocates  : 
Ej.  Powdered  fox  glove,  x.  grs.,  calomel,  vi.  grs.,  vale- 
rian, 9ii.,  assafcetidae,  castor,  each  5ss.,  sugar,  5i.  Mix, 
and  divide  into  twenty-four  powders.  Give  one  morning 
and  evening,  in  the  convulsions  attendant  on  hvdro- 
cephalus. 

Regime. — Nourishment  should  be  light,  as  arrow  root, 
milk,  tea,  &c.  When  it  cannot  be  taken  by  the  mouth 
it  may  be  given  by  way  of  injections. 


550 


DROPSY  OF  THE  CHEST. 


HYDROTHOKAX. 

Dropsy  of  the  Chest. — This  term  may  be  appropriately 
extended  to  any  case  of  serous  effusion  within  the  tho- 
racic cavity,  (chest)  and  it  is  now  more  generally  under- 
stood to  be  a  collection  of  water  in  the  pericardium,  (the 
membrane  which  surrounds  the  heart,)  or  in  the  cavities 
of  the  chest  itself;  frequently  liquid  is  diffused  in  the 
cellular  texture  of  the  lungs,  without  being  deposited  in 
the  cavity  of  the  thorax. 

Causes. — It  is  frequently  a  distinct  dropsical  affection, 
and  the  same  causes  which  have  a  tendency  to  produce 
other  species  of  dropsy  also  generate  this.  Mercury, 
when  used  improperly,  is  a  common  cause,  from  the 
effusion  and  debility  it  frequently  occasions;  it  some- 
times is  the  sequela3  following  inflammation  of  the  lungs 
or  liver. 

To  constitute  dropsy  the  effusion  must  be  so  consider- 
able as  to  derange  in  some  degree  the  healthy  functions. 

Symptoms. — When  there  is  sufficient  effusion  of  liquids 
to  derange  the  healthy  functions,  it  produces  more  or 
less  difficulty  of  breathing,  which  is  increased  by  any 
bodily  exertion,  there  is  a  sense  of  uneasiness  at  the 
lower  end  of  the  breast  bone,  which  is  increased  by  the 
least  exertion,  especially  walking  up  hill,  and  is  much 
greater  in  the  horizontal  than  in  the  erect  position. 
These  symptoms  are  sometimes  attended  by  a  cough, 
with  paleness  of  the  complexion,  and  slight  swelling  of 
the  extremities.  The  difficulty  of  breathing  is  slight  at 
first,  but  increases  rapidly  as  the  disease  advances,  and 
frequently  becomes  distressing  before  its  close;  the 
patient  cannot  remain  long  in  a  recumbent  posture,  he 
lies  preferably  on  the  side  most  affected,  with  the  head 
and  upper  part  of  the  trunk  almost  erect ;  in  the  ad- 


DROPSY  OF  TIIE  CHEST. 


551 


vanced  stages  of  the  disease  lie  is  frequently  unable  to 
lie  clown  at  all,  maintaining  almost  constantly  an  upright 
position;  it  is  frequently  accompanied  with  attacks  re- 
sembling spasmodic  asthma,  with  violent  palpitation  of 
the  heart.  When  the  effusion  is  very  great,  fluctuation 
can  sometimes  be  perceived  by  laying  one  hand  between 
the  ribs  and  striking  upon  the  opposite  side,  almost  the 
same  as  advised  in  ascites. 

I  have  seen  patients  laboring  under  the  most  dis- 
tressing symptoms;  in  general  the  face  and  extremities 
are  cold,  "the  pulse,  with  little  exception,  is  feeble, 
irregular,  and  intermits  in  a  degree  seldom  experienced 
in  other  disorders,  and  a  pain  or  sensation  of  numbness 
frequently  extends  itself  from  the  heart  towards  the 
insertion  of  the  muscles,  called  deltoid,  situated  at  the 
upper  portion  of  each  arm.  Excepting  a  livid  hue  of 
the  lips  and  cheeks,  the  countenance  is  pale,  and  indi- 
cates a  peculiar  anxiety  and  ghastliness  of  appearance, 
and,  together  with  the  upper  parts  of  the  body,  is  usually 
covered  with  a  profuse  clammy  persjiiration.  Drowsi- 
ness, coma,  or  delirium,  occasioned  by  the  difficult  trans- 
mission of  the  blood  through  the  lungs,  and  want  of 
sleep,  frequently  attend  the  latter  periods  of  hydro- 
thorax,  and  from  the  same  cause  the  expectoration  is 
sometimes  bloody.  Now  and  then  a  sensation  of  water 
floating  about  can  be  distinctly  perceived  by  the  patient 
on  any  sudden  change  of  posture.  The  urine  is  gene- 
rally scanty  and  very  high  colored,  like  brandy  or  beer. 
There  is  a  sense  of  tightness  or  stricture  across  the 
chest." 

Irregularity  and  intermission  of  the  pulse,  may  be 
regarded  as  amongst  the  most  frequent  attendants  on 


552 


DROPSY  OF  THE  CHEST. 


this  disease,  it  is  remarkable  that  in  some  few  cases 
these  symptoms  are  not  present. 

The  patient  sometimes  observes  that  he  has  a  sensa- 
tion as  if  water  were  contained  in  the  chest,  passing 
from  one  side  to  the  other  in  turning,  or  as  if  the  heart 
were  moving  in  a  fluid. 

The  natural  functions  are  variously  disordered  in  the 
progress  of  hyclrothorax ;  the  appetite  and  digestion  are 
sometimes  impaired,  the  tongue  foul  and  furred,  and  the 
bowels  are  various,  but  generally  bound.  The  pressure 
of  water  upon  the  oesophagus  has  sometimes  occasioned 
a  distressing  difficulty  of  swallowing. 

The  only  affections  with  which  this  disease  is  likely 
to  be  confounded  are  consolidation  of  the  lung  from 
pneumonia  or  other  cause,  and  the  presence  of  pus  or 
blood  in  the  cavity. 

Treatment. — In  regard  to  the  treatment  we  can  add 
but  little,  as  the  remedies  heretofore  advised  for  different 
species  of  dropsy,  are,  in  many  instances,  applicable  to 
this;  if  the  effusion  is  the  result  of  an  inflammatory 
condition  of  the  membrane  covering  the  lungs,  then  you 
will  derive  great  advantage  from  cupping,  which  should 
be  done  frequently,  accompanied  with  continued  and 
long  repeated  blistering. 

To  remove  the  effusion,  I  generally  administer,  in  this 
variety  of  dropsy, 

1^.    Mandrake,  (may  apple,) 
Cream  of  tartar, 
Peppermint  plant,  equal  parts. 

Some  substitute  the  powder  of  jalap  for  the  man- 
drake. 

Give  in  tea-spoonful  doses,  mixed  with  boiling  water, 
and  sweetened ;  you  must  repeat  according  to  circum- 


DROPSY  OF  THE  CHEST. 


553 


stances.  After  the  operation  of  the  medicine,  adminis- 
ter the  foxglove  as  advised  in  dropsy  of  the  head ;  it  is 
a  valuable  remedy  in  this  disease.  This  remedy  is 
facilitated  by  the  free  use  of  the  following  tea,  which  is 
strongly  diuretic : — 
^.  Spearmint, 

Parsley, 

Elder  flowers, 

Dandelion  roots  and  tops,  aa.  a  handful. 
Put  them  into  a  tea-pot,  and  add  sufficient  boiling 
water  to  make  a  strong  infusion.    This  should  be  drank 
freely  through  the  day. 

I  have  much  confidence  in  the  application  of  diuretics 
applied  externally,  in  dropsy  of  the  chest  and  abdomen, 
with  equal  parts  of  the  tinctures  of  digitalis,  squill,  and 
soap,  to  which  you  will  benefit,  by  adding  the  wine  of 
colchicum  and  the  tincture  of  cantharides ;  this  applica- 
tion should  be  rubbed  on  freely  two  or  three  times  a  day. 
Some  speak  in  high  terms  of  anointing  the  chest  and 
abdomen,  morning  and  evening,  with  warm  sweet  oil, 
to  which  they  add  a  few  grains  of  cayenne  pepper,  suffi- 
cient to  heat  or  stimulate  the  skin. 

If  you  succeed  with  the  remedies  pointed  out,  in 
evacuating  the  water  from  the  thorax,  to  prevent  its 
re-accumulation,  I  give  capsicum  in  ten  grain  doses, 
morning,  noon  and  night,  and  let  the  patient  use  wine 
bitters,  according  to  the  following  prescription. 
ty.    Comfrey  root, 

Solomon's  seal  root, 

Spikenard  root,  (bruised,)       aa.  Si. 

Chamomile  flowers, 

Colombo  root, 

Gentian  root,  (bruised,)         aa.  Bss. 


554 


DROPSY  OF  THE  CHEST. 


Place  in  a  vessel,  cover  with  boiling  water,  and  let 
the  compound  macerate  for  twenty-four  hours,  keeping 
it  closely  covered ;  then  add  of  good  sherry  wine  four 
pints,  macerate  for  two  weeks,  and  filter. 

Dose,  half  fluid  ounce,  three  or  four  times  a  day.  It 
is  well  to  give  it  on  an  empty  stomach. 

In  those  inveterate  and  almost  hopeless  cases,  if  the 
treatment  here  suggested  has  failed,  then  I  would  advise 
the  emetic  plan  of  treatment,  when  you  should  give  an 
emetic  every  third  day,  accompanying  it  with  the 
advantages  to  be  derived  from  a  vapor  bath,  with  the 
administration  of  the  compound  powder  of  jalap,  and 
the  decoction  of  Indian  hemp,  as  mentioned  in  dropsy 
of  the  abdomen. 

Some  very  respectable  authorities  assert,  that  they 
have  repeatedly  carried  off  the  effusion  by  the  use  of 
the  following  pills  : — 

1^.    Elaterium,  grs.  vi. 

Calomel,  grs.  xii. 

Eub  them  carefully  together,  and  with  a  sufficient 
quantity  of  extract  of  gentian,  form  into  twelve  pills. 

Give  one  every  hour,  commencing  early  in  the  morn- 
ing, and  continue  till  they  operate.  If  their  action  be 
excessive,  the  patient's  strength  must  be  supported  by 
the  wine  bitters  or  strong  beef  tea. 

Paracentesis  (tapping)  may  be  resorted  to  with  some 
hope  of  benefit,  when  there  is  reason  to  believe  that  the 
disease  has  originated  in  inflammation,  or  mere  vascular 
irritation  of  the  pleura.  In  other  cases,  it  would  be  a 
desperate  resort,  at  most,  calculated  to  afford  but  tem- 
porary relief,  at  the  hazard  of  producing  fatal  inflam- 
mation.   Nevertheless,  when  the  danger  of  death  from 


DROPSY  OF  THE  SCROTUM. 


555 


suffocation  is  imminent,  the  practitioner  would  be  jus- 
tified in  resorting  to  it  as  a  temporary  expedient.  In 
no  case  should  it  be  employed  until  all  other  means  had 
failed. 

We  call  your  attention  to  the  last  paragraph  on 
dropsy  of  the  cellular  membrane. 

A  strong  decoction  of  the  tops  of  common  broom,  is 
said  never  to  fail  in  increasing  the  flow  of  urine,  and 
to  be  especially  beneficial  in  this  form  of  dropsy. 

Dose,  of  a  strong  decoction,  four  ounces  every  hour, 
until  it  produces  some  effect. 

HYDROCELE. 

.  Dropsy  of  the  Scrotum. — There  are  certain  forms  of 
dropsy  that  belong  to  surgery,  and  need  only  to  be 
glanced  at  for  the  sake  of  elucidating  the  subject.  For 
example,  this  disease,  hydrocele,  is  sometimes  termed 
dropsy  of  the  tunica  vaginalis  testis,  and  there  is  also 
another  variety  belonging  to  surgery,  dropsy  of  the  joints 
and  bursse  (hydrarthrus.) 

Dropsy  of  the  scrotum  is  quite  a  common  disease 
amongst  us ;  it  consists  in  an  effusion  of  serum  or  water 
in  the  coats  of  the  testicle.  There  is  an  oedematous 
(swelling)  condition  of  the  scrotum  (vulgarly  termed  the 
bag)  which  may  be  mistaken  for  true  hydrocele.  There 
may  be,  also,  a  scirrhus  tumor  formed  which  gradually 
increases  and  sometimes  appears  transparent  and  elastic. 
There  is  frequently  fluctuation  of  water  which  can  easily 
be  discovered.  Great  care  is  absolutely  necessary  in 
discriminating  between  this  and  hernia  or  rupture. 
There  is  one  peculiarity,  which  is  very  marked,  to  dis- 
tinguish this  difference.    In  the  last  complaint,  the 


556 


DROPSY  OF  THE  SCROTUM. 


tumor  recedes  in  a  recumbent  position,  but  not  so  in 
the  former. 

Symptoms. — Hydrocele  is  an  accumulation  of  a  fluid 
in  the  tunica  vaginalis  (a  serous  membrane  inclosing  the 
testicle.)  It  generally  commences  at  the  bottom  of  the 
scrotum,  gradually  increasing  until  the  hag  becomes  very 
much  enlarged  and  distended,  extending  upwards  to- 
wards the  abdominal  ring ;  a  distinct  fluctuation  is  gene- 
rally to  be  distinguished ;  the  tumor  itself  is  pyriform 
in  shape,  and  elastic  to  the  touch ;  there  is  no  pain  on 
pressure,  unless  the  testicle  is  compressed,  and  no  disco- 
loration of  the  integuments ;  and  by  placing  the  patient 
where  you  have  a  strong  light,  for  instance,  between  you 
and  a  candle,  the  scrotum  is  almost  transparent;  the 
fluid  contained  is  most  generally  colorless,  sometimes 
slightly  yellow.  It  may  affect  persons  at  all  ages,  and 
even  exist  at  birth.  I  am  not  aware  that  I  have  ever 
seen  a  case  where  both  sides  of  the  scrotum  was  affected 
at  once. 

The  diagnosis  in  this  disease  is  sometimes  peculiarly 
difficult.  "  In  order  to  come  to  a  satisfactory  conclusion, 
you  should  examine  into  the  history  of  the  case.  Kecol- 
lect  that  hydrocele  proper  begins  in  the  form  of  a  tumor 
at  the  bottom  of  the  scrotum  and  gradually  ascends ; 
while  anasarca  of  the  scrotum  is  more  diffused.  Scirrhus 
of  the  testicle  presents  a  uniform  enlargement,  is  also 
accompanied  with  pain,  and  quite  heavy,  feeling  to  the 
patient  and  the  examiner  like  a  ball  of  lead.  In  hydro- 
cele, moreover,  where  recent,  before  the  membrane 
thickens,  the  whole  mass  of  the  tumor  below  the  sub- 
stance of  the  testicle  is  transparent  or  translucent,  as 
may  be  ascertained  by  placing  it,  when  the  room  is  dark- 
ened, between  your  eye  and  a  lighted  candle.    It  may 


DROPSY  OF  THE  SCROTUM. 


557 


be  distinguished  from  scrotal  hernia,  by  observing  that 
in  the  latter  case  the  tumor  commences  above  instead  of 
below,  and  if  the  patient  cough  the  swelling  will  be 
enlarged,  and  a  distinct  impulse  imparted  to  the  finger 
pressing  on  it also,  that  in  the  latter  the  tumor  recedes 
in  a  recumbent  position,  but  not  so  in  the  former. 

I  have  alluded  to  congenital  hydrocele  as  possessing 
some  peculiarities  ;  "  and  cases  of  the  same  kind,  which 
occasionally  occur  in  after  life,  are  incorrectly  called  by 
the  same  name.  The  original  connection  between  the 
tunica  vaginalis  and  the  peritoneum,  (the  membrane 
covering  the  bowels)  of  which  it  was  a  part,  continues, 
and  the  fluids  that  collect  in  the  cavity  of  the  abdomen 
descend  and  accumulate,  generally  producing  dropsy  or 
c  hydrocele'  of  the  tunica  vaginalis,  (the  serous  mem- 
brane covering  the  testicles)  as  well  as  of  the  spermatic 
cord.  This  may  be  distinguished  from  common  hydro- 
cele by  placing  the  patient  on  his  back  and  raising  his 
hips,  when  the  swelling  will  entirely  recede,  but  instantly 
reappear  when  the  erect  position  is  assumed.  The  other 
symptoms  of  hydrocele,  as  transparency,  &c,  have  to  be 
also  considered,  as  the  affection  may  be  mistaken  for 
hernia,  with  which  it  may  also  co-exist,  (the  same  cause 
occasioning  liability  to  both.") 

Treatment. — At  the  commencement  of  the  disease, 
especially  in  young  persons,  where  a  small  quantity  of 
fluid  is  only  collected,  and  where  the  absorbent  system 
seems  to  be  active,  you  may  disperse  it  by  constitutional 
means  and  external  applications.  I  am  fully  satisfied 
that  where  the  disease  occurs  in  children,  it  is  seldom 
necessary  to  evacuate  the  water  by  the  introduction  of 
the  trocar,  as  I  am  satisfied  they  can  be  cured  without 
the  aid  of  this.    You  should  begin  the  treatment  as  you 


558 


DROPSY  OF  THE  SCROTUM. 


would  in  dropsy,  where  there  was  an  effusion  of  liquid, 
by  the  administration  of  active  cathartics,  diaphoretics, 
and  diuretics,  frequently  repeated  for  a  considerable 
length  of  time. 

The  parts  should  be  fomented  every  day,  by  applying 
cloths  wrong  out  of  a  strong  decoction  of  bitter  herbs ; 
and  you  may  frequently  aid  absorption  by  suspending 
the  bag  and  wearing  a  "  T"  bandage.  Some  advise  very 
highly  stimulating  applications  to  the  scrotum,  such  as 
the  muriate  of  ammonia  and  vinegar  in  solution,  keep- 
ing the  parts  constantly  saturated  with  it.  Others 
again,  advise  astringent  applications,  and  I  have  tried 
them  successfully,  such  as  the  compound  tincture  of 
myrrh,  with  an  equal  quantity  of  marsh  rosemary,  or 
beach  drops.  After  suspension  of  the  bag,  absorption 
will  be  much  assisted  by  applying  gentle  pressure  to  the 
scrotum.  I  suggested,  many  years  ago,  an  india  rubber 
bag,  and  I  find  I  may  have  been  preceded  by  Dr.  Davis, 
of  Syracuse.  It  is  a  valuable  auxiliary  in  the  treatment 
of  this  disease.  Take  either  pf  the  preparations  advised 
and  completely  saturate  some  old  linen,  apply  it  around 
the  scrotum  and  pass  the  bag  over  it ;  it  should  be  suffi- 
ciently small,  to  exert  constant  and  uniform  pressure 
upon  the  scrotum.  I  have  cured  many  children  by  this 
mode  of  treatment. 

In  many  cases,  you  will  find  the  constitutional  and 
external  applications  will  fail  to  effect  a  permanent  cure ; 
in  that  case,  I  have  adopted  the  plan  of  a  physician 
who  made  no  pretensions  to  surgery,  as  the  most  simple, 
and  in  my  opinion,  attended  with  less  danger  than  the 
trochar :  seat  your  patient  in  a  chair,  grasp  a  portion  of 
the  tumor  between  its  anterior  and  inferior  parts,  with 
your  thumb  and  finger,  then  with  a  lancet,  make  a 


DROPSY  OF  THE  SCROTUM.  559 

small  puncture  or  incision,  by  which  the  contents  of  the 
scrotum  will  be  discharged ;  there  is  no  necessity  for 
the  trochar,  a  simple  puncture  is  all  sufficient.  As  soon 
as  the  water  discharges  itself,  a  tent  must  be  introduced 
into  the  orifice,  sufficiently  stiff  to  keep  the  wound  from 
healing ;  as  a  radical  cure  depends  in  a  great  manner 
upon  this  circumstance  ;  some  advise  after  the  incision, 
to  introduce  a  catheter  or  goose  quill,  there  cannot  be 
much  objection  to  this  course,  but  I  have  never  found 
necessity  even  to  do  this ;  should  any  difficulty  arise  in 
consequence  of  the  wound  healing  too  fast,  you  can 
apply  to  your  tent  a  mild  escharotic.  After  the  fluid 
has  been  entirely  evacuated,  some  advise  the  injection 
into  the  scrotum,  of  the  following  preparation,  every 
day  :  castile  soap  and  water,  to  which  a  small  quantity 
of  the  tincture  of  gum  myrrh  has  been  added.  Some 
advise  brandy  and  water,  port  wine ;  others,  the  pre- 
parations of  zinc  and  iodine ;  whether  any  of  these  is 
better  than  the  first,  I  am  not  prepared  to  say.  Should 
any  inflammation  follow,  you  must  apply  a  slippery  elm 
poultice,  and  let  the  patient  sit  over  the  vapor  of  hot 
herbs.  Dr.  Beech  advises  to  apply  on  the  lint,  a  plaster 
of  black  salve,  there  may  be  some  virtue  in  the  appli- 
cation. 

You  will  find  these  means  generally  effectual.  In 
some  chronic  cases  of  much  obstinacy,  you  may  have 
to  strengthen  your  injections  by  substituting  for  the 
ones  advised,  the  tincture  of  capsicum  and  blood-root. 
Recollect  in  all  cases  of  the  drawing  off  the  fluid,  you 
must  introduce  your  stimulating  injections,  not  forget- 
ting the  india  rubber  bag  and  supensory  bandage. 

For  hydrocele  of  the  spermatic  cord,  if  external  com- 
-  pression  and  stimulants,  aided  by  constitutional  means, 


560  DROPSY  OF  THE  CELLULAR  MEMBRANE. 

do  not  succeed,  I  should  recommend  the  insertion  of 
a  seton.  If  dropsy  of  the  cord  occurs  in  connection 
with  that  of  the  more  common  form  of  hydrocele,  the 
tapping  of  the  latter  relieves  the  cord  also. 

In  congenital  hydrocele,  or  other  cases  arising  from 
the  same  cause,  a  continued  connection  between  the  in- 
vesting membranes  of  the  testicle  and  of  the  bowels, 
merely  letting  off  the  fluid  for  the  time,  would  be  use- 
less ;  and  any  attempt  to  excite  inflammation  by  the 
usual  means,  would  be  endangering  the  life  of  the 
patient,  as  that  inflammation  would  be  very  likely  to 
extend  to  the  abdomen. 

You  must  first  close  the  communication  between  the 
abdominal  and  scrotal  cavities,  and  for  this  purpose,  a 
proper  truss  must  be  worn ;  some  advise  rubbing  over 
the  cavity,  oil  of  eggs,  procured  by  pressing  the  yolk, 
some  advise  wearing  the  irritating  plaster. 

In  ascites  or  dropsy  of  the  abdomen,  you  will  fre- 
quently have  with  it  in  connection,  hydrocele,  the  pres- 
sure of  the  fluid  sometimes  produces  a  rupture  in  the 
peritoneum,  and  you  will  find  the  communication  gene- 
rally between  the  tunica  vaginalis,  (the  membrane 
covering  the  testicles  and  abdomen.  The  truss  and  other 
means  above  recommended  for  closing  the  communica- 
tion, can  be  resorted  to  when  the  dropsical  tendency 
has  been  overcome. 

ANASARCA. 

Dropsy  of  the  Cellular  Membrane. — By  anasarca,  I 
understand  a  collection  of  serous  fluid  in  the  cellular 
tissue,  which  is  diffused  and  characterized  by  general 
tumefaction  of  the  whole  body.  I  do  not  apply  the 
term  to  the  cellular  tissue  of  internal  organs,  but  apply  ^ 


DROPSY  OF  THE  CELLULAR  MEMBRANE. 


5G1 


it  exclusively  to  the  exterior  cellular  membrane.  Where 
the  discharge  even  here  is  not  copious,  and  the  disease 
is  partial,  the  term  oedema  (swelling)  is  more  appro- 
priate. It  is  attended  with  a  loss  of  elasticity  of  the 
cellular  tissue  (or  skin,)  accompanied  with  paleness, 
softness,  and  generally  coldness. 

Symptoms. — The  first  sj^mptoms  which  attract  notice 
in  dropsy  of  the  cellular  membrane,  is  swelling,  which 
usually  commences  in  the  lower  extremities,  appearing 
towards  evening,  and  which,  for  a  time,  disappears  by 
the  morning;  it  soon,  however,  by  degrees,  extends 
upwards,  until  it  embraces  the  body.  The  intumes- 
cence, or  "swelling,  is  soft  and  very  inelastic,  easily  dis- 
tinguished from  any  other  swelling ;  by  pressing  upon 
it,  you  make  indentations,  and  these  indentations  or 
pitting  remain  for  a  time  before  the  parts  assume  their 
former  appearance.  In  this  disease,  I  ani  of  the  opinion 
that  the  effusion  takes  place  at  various  portions  of  the 
body  at  the  same  time ;  for  I  have  seen  the  tumefaction 
frequently  in  the  face,  affecting  more  particularly  the 
eye-lids ;  wherever  the  cellular  texture ^is  abundant  and 
copious,  for  instance  the  eye-lids  and  tops  of  the  feet, 
these  portions  frequently  become  greatly  distended. 
Where  the  disease  has  become  very  general,  the  effusion 
sometimes  passes  into  the  serous  cavities,  which  fre- 
quently causes  death. 

The  bowels  are  generally  more  or  less  constipated, 
the  urine  scanty,  high  colored,  depositing  sometimes  a 
reddish  sediment;  although  I  have  seen  some  cases, 
where  the  urine  was  directly  opposite  to  this,  being  of  a 
light  pale  color.  The  skin  is  dry,  seldom  any  perspira- 
tion ;  you  have  it  attended  with  a  sallow  countenance 
and  excessive  thirst,  a  corded  and  active  pulse,  with  a 
36 


562 


DROPSY  OF  THE  CELLULAR  MEMBRANE. 


coated  tongue ;  these  latter  symptoms,  however,  will  not 
always  do  to  rely  upon,  as  there  is  frequently  great 
difference.  Destitute  of  all  evidence  of  undue  excite- 
ment, we  have,  on  the  contrary,  the  indications  of  the 
extremest  debility — cold  surface,  feeble  circulation, 
scanty,  turbid  or  thick  urine,  emaciation,  and  the  gene- 
ral appearance  of  cachexy,  (a  bad  habit  of  the  body.) 
Towards  the  close  of  the  case,  whatever  may  have  been 
its  primitive  character,  much  torpor  and  heaviness  are 
betrayed,  with  a  low,  indistinct  fever,  the  skin  still 
colder  and  of  a  waxy  pallor;  the  distention  being  so 
considerable  as  to  force  the  fluid,  in  some  places,  through 
the  cutaneous  pores,  and  in  others,  where  the  tegument 
is  more  dense,  vesicles  or  blisters  form,  which  bursting, 
are  followed  occasionally  by  gangrene  and  mortification. 

Anasarca,  in  time,  presents  many  diversities;  some 
authors  divide  it  into  the  acute  or  chronic,  sthenic,  (that 
which  depends  upon  excessive  excitement,)  or  asthenic, 
(where  there  is  debility  of  the  whole  economy,  or  dimi- 
nution of  the  vital  forces,)  febrile  and  inflammatory,  or 
anemic;  (this  form  is  characterized  by  every  possible 
form  of  debility.)  Where  it  resembles  an  acute  febrile 
character,  the  lungs  are  apt  to  become  involved,  and 
you  have  a  sharp  or  dull  pain,  with  oppressed  respira- 
tion ;  the  swelling  also  is  decidedly  more  firm,  and  the 
impressions  made  by  pressure,  are  soon  effaced.  Where 
the  disease  is  dependent  on  an  asthenic  or  anemic  con- 
dition, the  swelling  is  soft  and  flabby;  it  pits  easily,  and 
the  indentations  remain  some  time. 

I  am  satisfied  that  this  form  of  dropsy  is  more  cura- 
ble than  any  other  variety,  when  it  is  restricted  to  the 
cellular  tissue,  and  induced  in  a  good  constitution ;  if, 
on  the  other  hand,  however,  it  is  occasioned  by  visceral 


DROPSY  OF  THE  CELLULAR  MEMBRANE.  5G3 

organic  lesions,  or  a  very  impure  state  of  the  system,  or 
if  complicated  with  any  other,  then  it  constitutes  an 
affliction  almost,  indeed,  hopeless. 

Causes. — A  writer  who  has  written  extensively  upon 
this  subject,  states  the  causes  as  follows : — Anasarca 
succeeds  severe  hseniorrhages,  natural  or  artificial, 
fevers  and  fluxes ;  and  it  frequently  occurs  in  the  latter 
stages  of  cliabetis,  pulmonary  consumption,  or  obstructed 
menses.  Under  such  circumstances,  the  dropsical  symp- 
toms commence  slowly,  and,  as  it  were,  imperceptibly. 

Exposure  to  cold  and  damp  has  frequently  been  fol- 
lowed by  dropsical  swellings. 

General  anasarca  arises  in  the  next  place,  from  excess 
in  the  use  of  spirituous  liquors. 

Another  cause  of  this  disease  is  disturbance  in  the 
uterine  functions. 

The  only  other  circumstance  requiring  attention  in 
anasarca,  is  its  connection  with  some  of  the  febrile  erup- 
tions. It  has  long  been  known  that  dropsy,  particularly 
in  the  form  of  anasarca,  occasionally  follows  scarlet 
fever.  The  same  phenomenon  is  sometimes  observed  as 
a  sequel  of  measles,  small  pox  and  erysipelas. 

Anasarca  is  closely  connected  with  hydrothorax, 
(dropsy  of  the  chest.)  In  many  cases  these  forms  of 
dropsical  effusion  co-exist,  and  the  remedies  are  the 
same  for  both. 

This  same  author  asks,  "  Is  it  not  probable  that  the 
first  cause  of  every  species  of  dropsy  exists  in  the  kid- 
neys, in  consequence  of  their  ceasing  to  perforin  their 
office,  or  failing  to  secrete  the  urine?"  Doubtless  in 
many  instances  such  is  the  case ;  but  our  impression  is, 
that  the  effusion  is  the  result  of  slight  and  diffused 
inflammation  of  the  cellular  membrane,  produced  from 


5G4  DROPSY  OF  THE  CELLULAR  MEMBRANE. 


the  causes  above  stated.  And  again  you  find  cases  of 
such  extreme  debility,  especially  when  it  is  attended 
with  tenuity  of  the  blood,  that  the  effusion  takes  place 
independent  of  any  excitement,  the  fluid  escaping 
through  the  relaxed  exhalents. 

Treatment. — A  great  many  contend  that  blood  letting 
controls  this  disease  as  if  by  enchantment.  I  have  had 
much  experience  in  the  treatment  of  dropsy,  and  have 
never  yet  been  compelled  to  resort  to  the  lancet,  and 
upon  the  whole,  would  view  it  as  a  dangerous  precedent 
to  be  established  in  the  treatment  of  dropsy  in  this  cli- 
mate. 

When  the  disease  has  proceeded  from  cold,  I  think 
diaphoretics  of  much  efficacy,  and  the  remedies  most 
clearly  indicated.  When  you  have  decided  inflamma- 
tory symptoms,  you  should  adopt  a  vigorous  treatment 
with  purgatives  in  combination  with  diaphoretics,  which 
will  generally  prove  adequate  to  the  removal  of  the 
effusion. 

When  the  swelling  is  confined  to  the  extremities,  the 
result  of  cold,  I  generally  make  a  strong  decoction  of 
bitter  herbs,  such  as  wormwood,  hops,  tansy  and  catnip, 
and  I  direct  the  legs  to  be  held  over  this  fomentation  until 
free  perspiration  is  produced,  and  immediately  after 
envelope  the  limb  with  oil  silk,  or  make  an  application 
of  wilted  cabbage  leaves,  or  the  tulip  poplar  leaves,  pre- 
viously soaked  in  hot  water ;  and  I  immediately  follow 
it  with  either  of  the  following  diaphoretic  powders  : 
^.    Pulv.  opium,  5ss. 

  camphor,  5m 

  ipecac,  5i- 

Cream  of  tartar,  Si. 
Mix,  and  give  ten  grains  three  or  four  times  a  day,  or 


DROPSY  OF  THE  CELLULAR  MEMBRANE. 


5G5 


Dover's  powders  in  five  grain  doses  every  hour  until  free 
perspiration  is  produced. 

The  action  of  these  medicines  will  be  greatly  facilita- 
ted by  either  of  the  following  infusions  : 

Tji.    Sanguinaria,  (alkaloid  principle  of  blood-root,) 
Hydrastis,  canad.,  (golden  seal,) 
Mysica  cerifera,  (bayberry,) 
Sumach  berries,  aa.  equal  quantities. 
Pulverize  them  well ;  take  an  ounce  of  the  mixture, 
and  add  one  pint  of  boiling  water.  Dose. — Table-spoonful 
every  15  or  20  minutes.  Or, 

R.  Catnip, 

Asclepias,  (pleurisy  root  or  butterfly  weed,)  aa.  Si. 
Xanthox.  berries,  (prickly  ash  berries,) 
Mentha  viriclis,  aa.  Sss. 

Make  a  strong  infusion,  and  drink  as  warm  as  pos- 
sible. 

If  there  should  be  inflammatory  symptoms,  decidedly 
active,  in  addition  to  the  treatment  before  suggested,  we 
resort  to  purgatives,  and  advise  either  of  the  following : 

Podophyllin,  grs.  x. 


These  ingredients  should  be  mixed  intimately  and 
thoroughly  in  a  mortar,  and  from  five  to  ten  grains 
should  be  given  every  three  hours,  until  catharsis  is 
produced,  at  the  same  time  alternating  your  cathartic 
with  the  following  diuretic,  which  I  conceive  is  entitled 
to  more  claims  than  any  remedy  within  my  knowledge, 
in  this  particular  form  of  dropsy  : 


Leptandrine, 
White  sugar, 


9u. 

5iss. 


566 


DROPSY  OF  THE  CELLULAR  MEMBRANE. 


^.    Gamboge  pulverized,  5ss. 
Carbonate  of  potash,  gi. 
Brandy,  jxii. 

Mix  the  powders  intimately ;  add  the  spirit  and  digest 
for  four  days  with  a  gentle  heat.  Given  in  doses  from 
a  half  to  one  drachm. 

The  following  is  highly  recommended ;  it  is  a  cathar- 
tic which  should  be  taken  about  twice  a  week,  viz : 

Ify.    Pulv.  jalap  root. 
Cream  of  tartar. 

Pulv.  spearmint,  equal  parts,  by  night. 
Mix.    Of  this  compound,  give  a  tea-spoonful  every 
three  hours,  until  it  acts  freely  upon  the  bowels.  The 
hydragogue  tincture  is  advised  to  be  used  in  combina- 
tion with  this.    It  is  as  follows  : 

3^.    Take  bark  of  sweet  elder,       1  pound. 
Good  wine,  1  gallon. 

Let  it  simmer  a  while,  say  an  hour,  strain  and  bottle. 
Dose,  a  wine-glassful  three  or  four  times  a  day,  accom- 
panying it  with  the  use  of  the  following  infusion  : 

3^.    Indian  hemp. 
Milk  weed. 

Dandelion  roots,  aa.  equal  parts. 
Make  an  infusion  and  drink  through  the  day. 

It  is  a  principle  now  that  is  well  established,  and,  I 
believe,  almost  universally  conceded,  that  mercury,  in 
this  variety  of  dropsy  is  regarded  as  beneficial;  per- 
haps in  those  instances  only,  where  the  glandular  vis- 
cera are  not  affected.  Yet,  as  an  agent  exerting  much 
influence  over  the  disease,  it  is  highly  extolled  by  many. 

I  have  succeeded  in  very  obstinate  cases  in  giving  relief, 


DROPSY  OF  THE  CELLULAR  MEMBRANE.  567 


by  giving  emetics,  repeated  frequently.  This  should  be 
used  two  or  three  times  a  week,  combining  it  with  the 
vapor  bath,  heretofore  alluded  to.  If  the  disease  should 
prove  obstinate,  you  should  administer  the  fox-glove ; 
either  of  the  following  will  answer  : 

^.    Foliorum  digitalis,  (fox-glove,)  3ss. 


Boiling  water,  Oss. 

Macerate  for  three  hours,  and  strain.  Dose,  table- 
spoonful  two  or  three  times  a  day ;  or, 

.ty,    Infusion  of  digitalis,  giv. 

Tincture  of  digitalis,  oi- 

Acetatis  potassae,  oi. 

Tincture  opii.,  gtts.  x. 


Mix,  and  give  table-spoonful  three  or  four  times  a 
day. 

The  prostrating  effects  of  digitalis  should  always  be 
recollected  by  the  physician ;  and  the  rule  that  when  it 
acts  upon  the  stomach,  the  bowels,  the  pulse,  or  the  kid- 
neys, it  should  be  discontinued,  cannot,  when  we  con- 
sider the  power  of  the  article,  be  too  scrupulously 
observed.  The  fox-glove  should  always  be  given  in 
spearmint  tea. 

If  the  urinary  secretion  is  deficient,  and  you  wish  to 
avail  yourself  of  a  stimulating  diuretic,  use  the  follow- 
ing, recommended  by  the  late  Dr.  Parrish  : 

ty.    Contused  juniper  berries. 

Seminum  Sinapaeos,  (mustard.) 

Kadicis  Zingiberis,  (ginger,)  aa,  gss. 

 Armoracia  contusaa. 

 Apii.  petroselini,  aa.  Si. 

Succi  expressi  et  fermenti  pomorum,  Oij. 


568 


DROPSY  OF  THE  CELLULAR  MEMBRANE. 


Infuse,  and  give  a  wine-glassful  three  or  four  times  a 
day. 

The  following  I  have  used  in  general  and  local  dropsy 
with  much  advantage : 

Contused  juniper  berries,  Siss. 
Cream  of  tartar,  Si. 
Boiling  water,  Oi. 
Infuse.    Give  a  tea-cupful  four  or  six  times  a  day, 
adding  forty  drops  of  spirits  of  nitre. 

Dr.  Dunglison,  in  his  "  New  Kemedies,"  recommends 
a  decoction  of  caincce,  a  Brazilian  plant,  which  has  of 
late  been  extensively  and  efficaciously  employed  in 
Europe. 

ty.    Caincge  root,  3ii- 
Water,  Oiss. 
To  be  gradually  reduced  by  heat  to  one-half.  Dose, 
table-spoonful  three  times  a  day. 

A  preparation  that  is  highly  extolled  by  Hufeland,  is 

Jfy.    Byony  root,  5i. 

White  wine,  1  pint. 

Boil  gently,  and  filter.  He  gives  it  in  wine-glassful 
doses. 

When  the  effusion  is  the  result  of  diseased  liver,  some 
authorities  of  much  experience  speak  in  high  terms  of 

ty.  Calomel. 

Pulv.  scilla?,  aa.     grs.  xii. 
Conserve  roses,      q.  s. 
Make  into  twelve  pills.    Give  one  night  and  morning. 
Where  it  is  dependent  on  this  and  other  visceral  obstruc- 
tions, the  preparation  of  mercury  and  digitalis,  as  re- 


DROPSY  OF  THE  CELLULAR  MEMBRANE.  569 

commended  in  a  preceding  article,  on  the  treatment  of 
dropsy,  might  be  very  valuable. 

A  liniment  that  has  been  employed  in  symptomatic 
anasarca,  is  the  following : 

ty.    Tincture  scillse,  (squills.) 

  digitalis,  aa.  Bii.  (fox  glove.) 

Mix,  and  apply  locally. 

To  prevent  a  relapse  in  all  dropsical  diseases,  you 
should  continue  the  remedy  that  has  afforded  relief 
sometime  after  the  cure  has  been  effected. 

I  have  now  given  my  views  of  the  management 
and  treatment  of  dropsy,  and  in  conclusion  I  wish  to 
call  your  attention  chiefly  to  the  regimen  to  be  observed 
in  dropsy;  and  the  remarks  of  Professor  Chapman  are 
so  much  in  unison  with  my  own  sentiments  that  I  adopt 
them. 

As  to  diet,  this,  of  course,  will  depend  much  on  the 
particular  circumstances  of  the  case.  In  the  active  or 
febrile  forms  of  the  disease  it  should  be  very  low,  and 
even  total  abstinence  for  a  season  has  proved,  we  are 
told,  of  utility.  What  medical  man  can  doubt  the  modus 
operandi  of  abstinence  under  such  circumstances  ?  The 
force  of  the  circulation  and  the  amount  of  blood  are 
diminished  by  inanition,  (starving)  and  it  is  a  law  fully 
recognized,  that,  in  proportion  to  these  effects,  are  the 
powers  of  absorption  invigorated. 

Dropsy  of  less  or  no  activity  demands  an  opposite 
course.  To  sustain  and  invigorate  the  system  by  a 
more  nutritious  and  generous  diet  is  here  proper.  Eggs, 
oysters,  or  jellies,  or  some  other  article  containing 
much  nutriment  in  small  bulk,  so  that  the  stomach  may 
not  be  oppressed,  should  be  preferred.    The  effects  of 


570  DROPSY  OF  THE  CELLULAR  MEMBRANE. 

diet,  however,  are  to  be  carefully  watched,  since  the 
filling  up  of  the  vessels  is  followed  sometimes  by  a  very 
manifest  increase  of  effusion,  and  when  this  happens  the 
food  must  be  reduced,  as  well  in  quantity  as  quality. 

Greater  differences  of  opinion  prevail  as  to  drinks. 
These,  instead  of  passing  off  by  the  natural  emunctories, 
are  sometimes  thrown  into  one  of  the  cavities  of  the 
body  or  cellular  membrane.  An  apprehension  which  has 
so  strongly  prevailed  with  some  as  to  lead  them  to  enjoin, 
as  much  as  possible,  a  forbearance  from  drinking,  and  it 
is  alleged  that  it  has  in  some  instances  effected  cures. 
Facts  of  the  kind,  however,  are  of  rare  occurrence,  and 
the  numerous  examples  of  the  total  failure  of  the  prac- 
tice have  led  finally  to  its  abandonment.  Difficult  and 
painful,  indeed,  is  it  to  resist  the  vehement  thirst  that 
often  attends,  and  by  the  continuance  of  which  such  a 
degree  of  irritation  is  induced  as  to  excite  or  exacerbate 
fever.  It  is  the  practice  to  allow  a  liberal  use  of  beve- 
rages. 

•  Common  water  may  answer  the  purpose,  though  water' 
impregnated  with  the  carbonate  of  soda,  or  the  tartrate 
of  potassa,  or  the  vegetable  acids,  particulary,  will  be 
found  more  agreeable,  and  of  superior  efficacy.  Cider 
and  water  is  a  very  pleasant  beverage  in  cases  of  this 
nature.  The  juniperberry  tea,  however,  is  still  more 
effectual,  and  so  is  an  infusion  of  the  buds  of  the  silver 
pine,  or  the  scabious,  (erigeron  heterophillum,)  or  of  the 
root  or  seed  of  parsley.  Gin,  or  whiskey  and  water  are 
allowable  in  weak  states,  and  especially  where  such 
liquors  were  formerly  used  to  excess.  Drinks  alone 
have  cured  dropsy,  on  the  authority  of  Cullen,  Baker 
and  Milman,  not  to  mention  other  names  of  nearly 
equal  respectability.     The  propriety,  indeed,  of  in- 


DROPSY  OF  THE  CELLULAR  MEMBRAXE.  571 

dulging  the  patient  in  this  respect,  is  so  incontestibly 
settled  by  the  concurrent  approbation  of  the  ablest 
practitioners,  that  it  would  be  superfluous  to  attempt  to 
enforce  it  by  any  theoretical  deduction,  or  by  a  recur- 
rence to  additional  authority. 

Granting  that  the  practice  proves  occasionally  pre- 
judicial, such  instances  can  be  deemed  only  exceptions 
to  a  very  general  rule,  and  the  mischief  is  so  easily  de- 
tected, as  to  be  at  once  guarded  against  or  arrested. 
Drinks,  when  instead  of  answering  the  purpose  of  their 
administration,  by -taking  a  wrong  direction,  serve  only 
to  increase  effusion,  and  enlarge  distention,  will,  by 
every  practitioner  of  sagacity,  be  timely  discontinued  or 
restrained. 

I  attach  much  importance  to  the  consideration  of  this 
disease,  and  cannot  forbear  drawing  your  attention  to 
those  lesions  which  frequently  remain  uncured.  It  is  alike 
required,  and  indeed  is  the  common  practice,  to  institute  a 
rigid  scrutiny,  or  overhaul,  as  it  were,  the  economy,  to 
detect  its  effects  and  apply  the  means  of  rectification, 
so  as  to  make  again  all  sound  and  durable,  or  as  far  as 
may  be  attainable. 

Much  of  the  early  treatment  of  dropsy,  when  well 
conducted,  is  certainly  calculated  \o  conduce  to  this 
end,  or,  in  other  words,  to  reinstate  the  order  of  health. 
Being,  however,  neglected,  or  our  efforts  not  entirely 
succeeding,  what  remains  to  be  done  is  no  longer  to  be 
postponed,  and,  perhaps,  from  a  clearer  apprehension  of 
the  nature  of  the  lesion,  on  the  evacuation  of  the  fluid, 
it  may  be  treated  with  greater  skill  and  efficiency. 
Nevertheless,  the  derangements  of  the  viscera  and 
tissues  involved  in  dropsy,  having  been  erected  into 
distinct,  substantive  affections,  claiming  as  such  a  sepa- 


572    .        DROPSY  OF  THE  CELLULAR  MEMBRANE. 

rate  and  ample  examination,  it  would  be  anticipating 
my  future  design,  or  a  recapitulation  of  what  has  pre- 
viously been  said,  to  indulge  in  any  details  regarding 
them  at  present. 

But  independent  of  such  positive  lesions,  or  any 
that  are  appreciable,  a  very  lively  predisposition  some- 
times ensues,  and  consequently  no  little  liability  to 
relapses.  The  causes  most  apt  to  re-excite  the  disease 
in  this  state  of  the  system,  are  exposures  to  cold,  indis- 
cretions in  eating,  the  abuse  of  spirituous  liquors  or 
other  stimulating  drinks,  and  similar  influences,  the 
avoidance  of  all  which  is  henceforth  to  be  forcibly 
impressed  and  faithfully  observed. 

No  latent  phlogosis  existing,  tonics  may  be  advanta- 
geously prescribed,  to  renovate  strength,  by  an  improve- 
ment of  the  digestive  and  nutritive  functions,  as  the 
vegetable  bitters  alone,  or  combined  with  preparations 
of  iron  the  sulphate  or  tartrate,  the  muriated  tincture, 
and  particularly  the  phosphate  of  iron.  During  this 
course,  should  any  tendency  fo  effusion  be  manifested, 
it  will  be  right  occasionally,  to  interpose  a  purgative,  or 
the  sorbentia,  and  here  the  carbonate  of  potash  with 
the  bitters,  is  adopted. 

Cold  bathing,  when  it  agrees  well,  the  test  of  which 
is  exciting  a  glow  to  the  surface,  is  said  to  be  serviceable, 
sometimes  so  in  ascites,  though  more  particularly  in  pure 
anasarca.  Dashing  the  water  on  the  extremities,  to  be 
followed  by  friction  with  the  hand  or  flesh  brush,  are 
likewise  so  in  the  latter  case.  Bandaging  to  support 
the  integuments  has  been  practised  with  utility  in 
anasarca  and  ascites.  In  hydrothorax,  I  should  con- 
sider the  application  of  cold,  under  all  circumstances,  to 
be  utterly  inappropriate,  no  disease  of  the  chest  bear- 


DROPSY  OF  THE  CELLULAR  MEMBRANE. 


573 


ing  its  impression,  generally,  in  whatever  way  employed. 
This  practice,  in  any  of  its  applications,  strikes  me  as 
hazardous,  and  should  never  be  adopted,  except  where 
the  constitution  is  vigorous  and  sound.  Disorganiza- 
tions of  the  viscera  existing,  which  so  often  happen,  I 
should  think  it  could  scarcely  fail  to  do  harm.  The 
warm  saline  bath,  on  the  contrary,  with  friction,  is  both 
safer  and  more  effectual,  operating  as  well  to  restore  the 
functions  of  the  skin,  so  essential  to  a  perfect  cure,  as 
in  various  other  modes. 

Exercise  is  eminently  calculated  to  cure  relapses,  and 
has  been  found,  in  some  rare  instances,  to  cure  the  dis- 
ease itself. 

We  would  remark,  before  closing  this  article,  that  the 
garden  artichoke  is  reputed  to  be  a  very  beneficial 
remedy  in  most  every  variety  of  dropsy ;  it  is  recom- 
mended in  the  form  of  tincture.  The  leaves  should  be 
fresh  and  the  preparation  made  from  them,  and  quickly 
used. 

Dose  of  the  tincture,  a  drachm,  with  five  grains  of 
the  extract,  three  times  a  day. 

The  ijolytrichum  juniperum,  (ground  moss,) — it  is  a 
powerful  diuretic,  in  strong  infusion.  In  doses  of  two 
ounces  of  the  infusion  every  half  hour,  it  has  been 
known  to  remove  from  a  dropsical  patient  from  twenty 
to  forty  pounds  of  water,  in  the  space  of  twenty-four 
hours ;  it  has  done  this  in  my  hands.  It  may  be  used 
in  connection  with  hydragogue  cathartics,  or  even  alone, 
in  dropsies,  with  the  most  decided  advantage ;  and  it  is 
a  very  useful  article.  Professor  Jones  considers  it  wor- 
thy to  be  ranked  among  the  first,  if  not  at  the  head  of 
the  class  of  diuretics. 


574 


GONORRHEA. 


VENEREAL  DISEASES, 

GONORRHEA. — CLAP. 

Gonorrhea. — This  is  a  disease  too  well  known  to  re- 
quire an  elaborate  description ;  it  is  peculiar  to  the 
human  species,  and  may  be  defined  as  a  specific  inflam- 
mation, produced  by  the  immediate  contact  of  a  virus, 
applied  to  the  human  body ;  it  is  most  generally  the 
product  of  the  above  inflammation  with  the  mucous 
membrane  of  the  urethra,  generally  communicated  in 
the  act  of  coition ;  the  infection  can  be  communicated 
to  any  portion  of  the  body  wherever  the  virus  comes 
in  contact  with  an  abraded  surface.  . 

The  disease  most  generally  arises,  from  illicit  inter- 
course between  the  sexes,  and  the  first  symptoms  are 
made  manifest  in  or  about  the  organs  of  generation. 
There  are  two  varieties  of  venereal  disease — the  one 
under  consideration,  and  (Syphilis)  Pox. 

A  very  distinguished  author  styles  this  a  loathsome 
affection,  which  extends  to  every  part  of  the  system, 
and  is  occasioned  by  a  specific  poison,  conveyed  by  con- 
tagion or  actual  contact ;  and  asserts,  that  it  arises  from 
a  poison,  which,  when  applied  to  the  human  body,  has 
the  power  of  propagating  or  multiplying  itself,  and  is 
capable  of  acting  both  locally  and  constitutionally. 

Dr.  Steward  supposes  that  this  disease  originated  in 
the  camp  of  Israel,  as  may  be  inferred  by  reading  the 
5th  chapter  of  Numbers ;  and  he  says  he  has  no  doubt 
it  was  first  inflicted  upon  mankind  as  a  curse,  in  conse- 
quence of  departing  from  moral  rectitude  or  the  law  of 


GONORRHEA. 


575 


God.  The  first  symptoms  indicated  in  this  disease,  are 
made  manifest  in  from  three  to  five  days  after  the  con- 
nection, and  it  is  generally  ushered  in  with  a  disagree- 
able itching  or  burning  pain  in  the  glans  penis,  or 
attending  the  urinary  discharge.  This  sensation  is  gene- 
rally experienced  in  the  urethra,  a  short  distance  from 
the  orifice,  soon  after  which  large  quantities  of  purulent 
matter,  resembling  pus,  are  thrown  out. 

The  discharge  at  first  is  small  and  thin,  in  the  course 
of  a  few  days  it  increases,  rapidly,  becomes  thicker  and 
of  a  yellowish  color.  The  mouth  of  the  urethra  becomes 
inflamed  and  swollen,  and  causes  a  frequent  desire  to 
urinate,  which  is  the  source  of  much  annoyance  from 
the  pain  and  scalding  heat  that  is  experienced  at  every 
attempt  to  make  water.  A  local  symptom,  that  is 
an  attendant  most  generally,  is  involuntary  and  spasmo- 
dic erection ;  it  occurs  most  frequently  after  the  patient 
has  been  in  bed  for  some  time.  The  inflammation  pre- 
vails to  a  very  high  degree,  and  prevents  the  extension 
of  the  urethra  on  the  taking  place  of  an  erection,  so  that 
the  penis  is  most  generally,  from  this  fact,  curved  down- 
wards, attended  with  much  pain,  which  is  enormously 
increased  if  you  attempt  to  straighten  it.  This  peculiar 
species  of  priaprism  is  called  chordee.  The  inflamma- 
tion, which  acts  as  a  stimulus,  occasions  the  penis  to 
assume  this  downward  tendency,  more  especially  when 
the  patient  is  asleep ;  and  the  pain  is  at  times  so  excru- 
ciating as  to  produce  an  involuntary  discharge  of  semen. 

The  inflammation  and  irritation  may  extend  to  the 
neighbouring  organs.  An  aching  is  sometimes  experi- 
enced in  the  testicles  and  loins,  extending  down  the 
thighs."    The  lymphatic  glands  in  the  groin  may  swell, 


576 


GONORRHEA. 


giving  rise  to  buboes,  though  these,  it  should  be  remem- 
bered, may  result  from  any  other  irritation. 

The  constitutional  symptoms  are,  in  general,  but 
slight.  In  certain  states  of  the  system,  however,  consi- 
derable sympathetic  fever  may  be  developed. 

It  is  asserted,  and  by  experience  confirmed,  that  a 
first  clap,  in  a  large  majority  of  cases,  is  generally  more 
severe  than  subsequent  ones. 

Its  more  serious  occasional  results  are  inflammation 
of  the  glans  penis  and  prepuce,  testes,  prostrate  gland 
or  bladder. 

We  have  as  sequela  following  this  disease,  especially 
where  there  is  a  peculiar  idiosyncrasy  of  constitution, 
acute  rheumatism,  and  sometimes  the  gout.  A  large 
majority  of  authors,  however,  differ  with  me  in  regard 
to  this  opinion,  and  attribute  the  sequela  rather  to  the 
treatment  than  the  disease. 

The  first  consideration  in  regard  to  this  disease  is  to 
institute  an  inquiry,  and  if  possible,  ascertain  how  it  can 
be  prevented." 

"  The  condom,  if  perfect,  is,  of  course,  an  absolute 
preventive.  To  insure  this,  however,  it  cannot  be  used 
the  second  time  without  having  been  thoroughly  washed 
in  a  soap  of  a  very  costly  kind.  Persons  who  use 
these  instruments,  which  in  special  cases  are  recom- 
mended by  surgeons,  both  to  prevent  conception  and 
infection,  purchase  them  by  the  package,  and  run  no 
risk  from  the  second  use." 

There  would  be  very  little  danger  of  contracting  this 
disease  if  the  parties  would,  immediately  after  connec- 
tion, indulge  freely  in  ablutions  of  soap  and  water,  and 
excite,  at  the  same  time,  if  possible,  urinary  discharges. 


GONORRHEA. 


577 


I  am  positive  as  to  this  assertion,  and  conscientiously 
believe,  that  if  a  systematic  course  of  proper  police  regu- 
lations were  instituted,  that  this  disease,  in  the  space  of 
a  few  years,  would  be  entirely  eradicated. 

There  may  be  doubts,  which  are  just  and  legal  ones, 
as  to  the  right  to  pass  laws  restraining  the  human  family 
from  indulging  in  their  various  appetites.  It  would 
probably  be  a  dead  letter  upon  the  statute  book  to  enact 
or  attempt  to  pass  a  law  in  this  country  against  fornica- 
tion; but  how  just  would  it  be  to  pass  a  law  which 
would  prevent  one  person  from  poisoning  another  by  the 
spread  of  such  an  infectious  malady  ?  It  is  manifest  to  my 
mind,  that  when  this  disease  is  communicated  wilfully, 
that  it  should  be  treated  as  a  misdemeanor  of  a  very 
serious  character. 

We  have  a  species  of  venereal  disease  which  is  fre- 
quently brought  on  by  excess  in  venereal  indulgence ; 
this  we  call  pseudo  gonorrhea.  It  is  said  that  contact 
with  the  menstrual  fluid  will  sometimes  occasion  ure- 
thral inflammation  in  the  male,  with  most  of  the  other 
suspicious  symptoms,  and  also  that  leucorrhea  is  still  more 
generally  believed  capable  of  producing  the  same  result. 
Some  assert  that  is  the  cause  that  originally  produced 
the  disease,  and  is  still  reproducing  the  true  gonorrheal 
virus. 

Our  business  is  not  so  much  with  the  causes  that  pro- 
duce this  disease,  as  with  the  attending  consequences 
resulting  therefrom.  Unfortunately  gonorrhea  has  been 
too  generally  regarded  and  too  much  treated  as  a  mere 
local  affection.  An  author,  who  has  had  considerable 
observation  in  this  disease  coincides  with  me  in  opinion, 
and  says,  that  it  is  no  more  exclusively  a  local  affection 
than  rheumatism  or  gout.  You  might  as  well  say  that 
37 


578 


GONORRHEA. 


these  are  respectively  only  an  inflammation  of  the  small 
or  large  joints,  and  with  equal  propriety  assert  that  small- 
pox is  a  simple  disease  of  the  skin,  as  that  gonorrhea  is 
nothing  but  a  diseased  condition  of  the  mucous  membrane 
of  the  part  where  it  shows  itself.  "We  have  symptomatic 
fever  and  other  general  as  well  as  local  symptoms ;  these 
latter  are  frequently  attempted  to  be  removed  by  what  is 
termed  the  abortive  treatment,  which  when  effectual  is 
pleasing  to  the  patient,  who  is  not  aware  that  the  virus 
in  question  can  be  so  readily  removed  from  the  system. 

I  am  fully  of  the  opinion  that  a  majority  of  the  cases 
treated  on  the  abortive  plan  will  sometimes,  years  after- 
wards, develope  themselves  in  the  same  or  some  worse 
form,  whenever  any  sufficient  exciting  cause  may  ope- 
rate. A  distinguished  author  asserts  that  it  renders  the 
patient  much  more  liable  to  rheumatism ;  or,  on  expo- 
sure to  malaria,  be  more  certain  to  bring  on  an  attack 
of  intermittent  fever.  We  have  witnessed  instances  where 
the  urethral  discharge,  with  all  the  primary  symptoms 
of  gonorrhea  reappeared  during  the  progress  of  a  bilious 
intermittent.  The  appearance  of  the  disease  after  vio- 
lent over-exertion  is  by  no  means  uncommon.  Loss  of 
sleep,  anything  that  causes  debility,  will  readily  bring  it 
back,  where  it  has  been  imperfectly  treated,  or  prema- 
turely arrested.  Numerous  other  instances  might  be 
adduced  of  the  mischief  of  an  exclusively  local  treatment. 
Of  all  these,  however,  perhaps  stricture  of  the  urethra,  is 
the  worse  and  most  common  result  of  curing  up  a  clap 
by  the  fashionable  astringents. 

Treatment. — When  you  are  called  to  treat  a  case  of 
gonorrhea,  you  should  first  endeavor  to  rid  or  clear  the 
system  of  the  virus,  and  to  do  this  you  should  resort  to  a 
thorough  and  perfect  antiphlogistic  regimen,  and  a  brisk 


GONORRHEA. 


579 


purge  of  senna  and  salts,  or  an  emeto  cathartic,  composed 
of  the  compound  senna  powder  or  syrup,  cream  of  tartar, 
and  may-apple ;  half  drachm  doses  to  be  taken  every 
two  hours  until  free  purging  is  produced.  These  reme- 
dies themselves  have  frequently  prevented  the  develop- 
ment of  the  disease  wrhen  its  first  symptoms  had  made 
their  appearance.  Still  any  symptom  indicating  the  dis- 
ease, is  sufficient  to  put  the  patient  on  his  guard,  and 
call  for  a  continuance  of  treatment.  After  the  action  of 
the  cathartic  we  generally  resort  to  mucilaginous  diure- 
tics, such  as  a  strong  infusion  of  burdock,  in  connection 
with  the  diuretic  drops,  which  are  composed  of  the  fol- 
lowing : 

I£.    Sweet  spirits  of  nitre. 
Oil  of  almonds,  aa.  Su\ 
Balsam  copaibae. 
Oil  of  turpentine,  aa.  5i. 

Mix  these  together,  and  add  camphor  in  powder,  one 
scruple.  Dose,  one  drachm  three  times  a  day,  in  the 
mucilaginous  drink.  Some  add  to  this  recipe  one-fourth 
the  quantity  of  the  tincture  of  cubebs. 

After  the  action  of  these  medicines  you  can  resort  to 
local  applications,  which  are  useful  as  palliatives  in  con- 
nection with  the  foregoing  treatment.  For  this  purpose 
I  frequently  use  a  cold  saturated  solution  of  borax  as  an 
injection,  in  combination  with  salaeratus,  in  the  pro- 
portion of  two  drachms  to  the  pint.  In  quite  a  number 
of  cases  in  connection  with  the  foregoing  treatment,  I 
have  used  the  following  recipe  with  very  few  failures  : 

^.    White  vitriol,       grs.  x. 
Sugar  of  lead. 


580 


GONORRHEA. 


Borax,  aa.  9i. 
Elm  bark,  pulv'd,  grs.  x. 
Hot  water,  Oss. 


Inject  from  five  to  six  times  per  day.  I  have  used 
warm  water  injections  in  the  acute  stage  beneficially. 
Injections  of  a  solution  of  nitrate  of  silver  from  two  to 
twelve  grains  to  the  ounce,  according  to  circumstances, 
are  strongly  recommended  by  Carmichael,  and  other 
surgeons,  it  is  a  valuable  remedy,  but  should  be  resorted 
to  only  in  cases  of  emergency. 

A  preparation  that  I  have  used  with  unparalleled 
success  is  the  liquid  chloride  of  zinc,  twenty-four  to 
thirty-six  drops  in  four  ounces  distilled  water;  this  pre- 
paration should  be  agitated  and  filtered  through  paper ; 
of  this  recipe  inject  a  very  small  quantity  about  an  inch 
up  the  urethra  some  two  or  three  times  a  day,  it  pro- 
duces slight  swelling  of  the  glands,  but  is  most  certain 
to  cut  short  the  disease.  The  revulsive  treatment  is 
much  practised  in  the  French  hospital,  it  consists  in  the 
application  of  leeches  and  counter  irritation  to  the  peri- 
neum, in  connection  with  powerful  doses  of  copaiba, 
cubebs,  and  similar  remedies,  the  following  recipes  come 
under  this  head : 


Mix,  and  divide  into  nine  powders,  give  one  three 
times  a  day. 


3$*.    Pulv.  cubebs, 
Pulv.  alum, 


gii. 
Sss. 


Or, 


3^.  Pulv.  cubebs,  gi. 
Holland  gin,  Oi. 
Spearmint,  Si. 


GONORRHEA. 


581 


Mix,  and  let  it  stand  to  digest,  theif  take  balsam 
copaiba,  gii.,  oil  of  wintergreen,  1  drachm,  mix  each  of 
the  above  preparations  together,  and  give  two  tea-spoons- 
ful three  times  a  day. 

When  the  disease  is  of  a  very  mild  character,  unac- 
companied with  pain  or  inflammation,  I  have  then  but 
little  doubt  that  it  may  be  cured  with  astringent  injec- 
tions, especially  if  the  bowels  be  kept  in  a  soluble  con- 
dition, and  the  patient  be  allowed  to  drink  freely  of 
barley  or  flaxseed  tea,  with  the  addition  of  small  doses  of 
the  nitrate  of  potash,  which  corrects  the  irritating 
qualities  of  the  urine.  He  should  observe  a  strictly 
antiphlogistic  diet,  abstaining  from  all  malt,  vinous  dis- 
tilled liquors,  and  from  everything  calculated  to  excite. 
Keep  the  mind  as  free  as  possible  from  lascivious  ideas. 

The  second  stage  of  gonorrhea  is  attended  by  more 
extensive  suppuration,  violent  scalding,  frequent,  almost 
constant  erections,  producing  that  peculiar  condition  of 
the  penis  called  chordee,  attended  sometimes  with  bleed- 
ing more  or  less  from  rupture  of  the  urethra.  When 
this  stage  is  fully  formed  with  its  inflammatory  tenden- 
cies, injections  will  be  of  little  use,  and  frequently 
aggravate  the  symptoms;  the  chordee  may  be  removed 
upon  the  application  of  cold  water,  and  may  be  effectu- 
ally controlled  by  pills  of  opium  and  camphor,  either 
taken  hi  the  usual  manner  or  pushed  up  the  rectum. 
Copaiba  in  capsules  can  be  administered  in  the  same 
manner  when  it  disagrees  with  the  stomach.  We  have 
asserted  that  injections  in  the  second  stage  are  of  little 
use,  but  I  must  confess  that  I  have  received  much  benefit 
by  the  injections  of  cold  water,  and  more  especially  those 
made  from  a  decoction  of  poppy  heads  as  warm  as  they 
can  be  borne,  and  forming  the  solid  contents  of  the  de- 


582 


GONORRHEA. 


coction  into  a  poultice,  and  applying  it  externally  to  the 
penis;  by  these  means  I  have  seen  the  inflammation 
rapidly  allayed,  and  when  chordee  existed  at  the  same 
time,  that  symptom  quieted. 

Some  practitioners  resort  to  general  blood  letting,  in 
the  inflammatory  state  of  this  disease ;  we  do  not  adopt 
the  method,  having  never  had  any  difficulty  in  control- 
ling the  inflammatory  action  which  attends  the  progress 
of  the  disease,  by  using  freely  of  ipecac,  given  to 
the  extent  of  producing  nausea,  when  the  inflamma- 
tion has  been  controlled,  you  must  resort  to  the  anti- 
gonorrheal  remedies.  Prevent  erections,  this  can  be 
effected  by  keeping  the  parts  elevated,  and  by  the  appli- 
cation of  cold  lotions. 

The  disease  sometimes  resists  the  usual  applications 
of  remedies,  in  such  cases  you  are  justified  in  using  in- 
jections of  the  strongest  possible  nature,  of  nitrate  of 
silver.  With  a  patient  in  such  a  condition,  the  inflam- 
mation must  be  reduced  by  general  and  local  treatment, 
applying  blisters  along  the  bottom  of  the  penis  and 
perineum,  followed  by  wet  cloths ;  you  may  inject  a 
small  portion  of  warm  water,  and  a  tea-spoonful  of 
laudanum,  up  the  rectum,  to  control  the  chordee,  if  it 
should  be  an  attendant  symptom ;  under  this  course,  if 
the  inflammation  should  not  have  subsided,  you  must 
introduce  a  catheter  very  slowly,  well  lubricated  with 
an  ointment  containing  a  large  portion  of  the  extract  of 
belladona.  In  this  stage  you  may  resort  to  frictions, 
with  laudanum  and  emolient  cataplasms,  but  the  treat- 
ment at  this  point  becomes  more  general  than  specific. 

An  author  of  much  celebrity,  advises  a  simple  course 
of  general  treatment,  which  he  was  assured  by  an 
eclectic  practitioner,  in  whose  hands  there  had  been 


GONORRHEA. 


483 


no  failure  in  hundreds  of  cases,  and  whicli,  he  says,  he 
has  tested  satisfactorily  ;  it  is  as  follows  : 

The  patient,  after  being  directed  to  bathe  thoroughly 
in  alkali,  and  drink  copiously  of  some  demulcent 
diuretic,  is  given  a  five  grain  pill,  composed  of  equal 
parts  of  podophyllum,  (mandrake) .  Iris  versicolar  (blue 
flag,)  and  cubebs,  moistened  with  the  balsam  of  fir  or 
copaiba.  This  pill  is  repeated  every  three  or  four 
hours,  or  often  enough  to  produce  from  five  to  eight 
operations  daily.  This,  he  says,  has  effectually  checked 
the  violent  symptoms,  in  the  course  of  a  few  hours  after 
the  first  operation  from  the  bowels,  and  often  in  forty- 
eight  hours,  entirely  eradicated  the  disease  ;  in  connec- 
tion with  these  pill he  uses  injections  similar  to  those 
I  have  directed. 

In  all  cases,  however,  he  directs  that  the  patient 
should  be  cautioned,  after  the  discharge  has  disappeared, 
not  to  discontinue  the  bathing  for  three  or  four  weeks  ; 
and  during  at  least  as  long  a  period,  the  pills  should  be 
occasionally  used  as  directed.  A  plan  of  treatment 
which  is  highly  extolled,  is  to  let  the  patient  take  before 
each  meal,  and  at  bed  time,  fifteen  grains  balsam 
copaiba,  drinking  in  the  intervals,  as  much  as  the 
stomach  can  bear,  of  a  decoction  of  star  grass  or  uni- 
corn, and  taking  a  dram,  often  enough  to  keep  the 
bowels  freely  loose,  of  bitters,  prepared  by  dissolving 
two  ounces  aloes  in  a  quart  of  common  whiskey.  The 
treatment  that  was  peculiarly  successful  with  our  army 
in  Mexico,  was  in  the  first  place,  to  take  the  cathartic 
we  have  prescribed,  this  was  followed  on  the  next  day, 
and  perhaps  the  next  two  days,  with  gentler  saline  pur- 
gatives— the  sulphate,  tartrate  or  citrate  of  potash.  A 
single  dose  of  one  of  these,  sufficient  to  act  freely  on 


584  GONORRHEA. 

the  bowels,  was  even  sometimes  found  after  the  more 
drastic  purge,  to  completely  remove  all  symptoms. 
When  this  did  not  happen,  the  bowels  were  still  kept 
loose,  and  the  following  injection  ordered  for  the 
urethra  : 

fy.    White  vitriol,  grs.  vi. 

Sodae  bor.,  grs.  x. 

Pulv.  slippery  elm,  grs.  x. 

Water,  Sii. 

To  this  was  sometimes  added,  when  the  urethra  was 
particularly  irritable,  ten  grains  of  belladonna;  this 
lotion  was  found  very  useful  where  chordee  was  present, 
and  also  in  cases  of  recent  stricture.  After  the  opera- 
tion of  the  active  cathartic,  the  patient  was  ordered  a 
bolus  or  pills,  composed  of  equal  parts  of  balsam  of 
copaiba  and  white  wax,  melted  together,  with  oil  of  spear- 
mint, added  when  cold,  one  ounce  of  this  to  four  ounces 
of  the  mixture.  Twenty  grains  of  this  was  ordered 
four  times  a  day. 

It  is  due  to  a  very  distinguished  physician,  who  really 
believes  he  has  a  specific  to  control  this  disease,  to  state 
his  treatment.  He  takes,  while  in  blossom,  equal  parts  of 
the  tops  of  the  male  and  female  hemp,  (canabis  sativa,) 
about  18  inches.  He  bruises  them  in  a  mortar  and 
expresses  the  juice,  adding  an  equal  portion  of  alcohol. 
He  gives  it  in  doses  of  one  to  three  drops  every  two  or 
three  hours.  I  have  had  no  experience  with  the  reme- 
dy ;  it  may  possess  the  virtues  that  are  claimed  for  it. 

Women. — With  them  this  disease  is  comparatively 
mild  in  its  symptoms,  and  most  generally  of  easy  cure. 
In  the  first  stages  it  is  scarcely  noticed,  and  as  it  is  so 
liable  to  be  confounded  with  other  discharges,  the  phy- 


GONORRHEA. 


585 


sycian  seldom  has  an  opportunity  of  testing  what  is 
called  the  abortive  treatment.  When  the  disease  does 
exist,  astringent  injections  heretofore  advised  may  be 
used,  and  the  patient  will  be  apt  to  find  relief  from  the 
revulsive  treatment  of  cubebs  and  copaiba.  The  most 
important,  and  I  may  say  the  principal  means  of  cure,  is 
the  antiphlogistic  treatment,  according  to  the  symptoms, 
such  as  cleanliness,  baths,  injections,  demulcent  drinks, 
and  emolient  and  narcotic  fomentations.  An  author  of 
much  celebrity  and  experience  says,  that  perhaps  the 
most  effectual  means  of  all  are  the  isolation  or  separation 
of  the  affected  parts  from  each  other,  and  rest.  A  tam- 
pon of  fine  lint  of  sufficient  size  should  be  introduced 
into  the  whole  extent  of  the  vagina,  and  moistened  seve- 
ral times  a  dajf  with  a  solution  of  the  acetate  of  lead 
and  sulphate  of  zinc ;  or  the  vegetable  astringent  lotions 
may  be  sufficient. 

There  are  cases  in  which  the  acute  stage  does  not 
yield  readily  to  antiphlogistics,  emolieilts  and  astringents. 
In  such  cases  you  must  apply  nitrate  of  silver  injec- 
tions, by  means  of  lint,  to  produce  superficial  cauteriza- 
tion, after  which  the  sides  of  the  vagina  must  be  kept 
apart  by  dry  lint,  which  will  aid  materially  in  the  cure. 

After  the  acute  state,  the  treatment  should  be  active 
to  effect  a  speedy  resolution.  The  strength  of  the  solu- 
tions used  •  as  injections,  or  with  the  tampons,  may  be 
increased  at  this  time,  and  will  generally  produce  a 
cure ;  but  in  many  cases  more  tonic  applications  must  be 
resorted  to,  such  as  a  decoction  of  oak  bark,  with  equal 
parts  of  sulphate  of  alum  and  zinc,  and  even  corrosive 
sublimate  is  sometimes  employed. 

This  disease  sometimes  produces  retention  of  urine. 


586 


GONORRHEA. 


If  you  resort  to  the  catheter,  it  must  be  applied  with  as 
little  irritation  as  possible. 

Emolient  fomentations  and  injections  should  be  tepid; 
but  resolvents,  astringents  and  tonics  should  be  applied 
cold. 

The  following  recipes  I  have  selected  as  enjoying  the 
confidence  of  a  very  large  portion  of  my  medical  breth- 
ren. They  have  stood  the  test  of  time,  and  will  con- 
tinue to  be  used,  most  probably,  as  long  as  this  disease 
prevails. 

Pills. 

Jfy.    Camphorse  pulv., 

Ext.  Gum  opii,        grs.  viii. 
Mucilage,  .    q.  s. 

Mix  and  divide  into  sixteen  pills ;  given  in  doses  of 
two  or  three  every  evening,  to  allay  irritation  in  the 
neck  of  the  bladder,  chordee,  &c. 

Mixtures. 

ty.    Copaibse  resin, 
Alcohol, 

Syrup  balsam  tolut.,  aa.  Si- 
Aqua  menth.  pip.,     (Peppermint  water.) 
Aqua  flor.  aurantii,  (Orange  flower  water.) 
Sp.  setheris  nitrici,    3ii.    (Sweet  spirits  nitre.) 
Mix.    Dose  from  two  to  six  table-spoonsful  daily. 

This  is  a  formula  of  Chopard,  that  is  much  celebrated 

in  France. 

^.    Copaibaa  balsam, 

Sp.  a3theris  nit.,  aa.  Sss. 

Pulv.  Gum  arabici, 

Pulv.  sacch.  alb.,        aa.  5i.    (Loaf  sugar.) 


GONORRHEA. 


587 


Sp.  lavand.  comp.,  5ii. 
Tinct.  opii,  3i- 
Aqua  destill.,  Siv.    (Distilled  water.) 

F.  M.    A  table-spoonful  for  a  dose,  three  times  a  day. 

fy.  Pulv.  cubeboe,  Si. 
Sulphat.  alum  et  potassa,  3i- 
Pulv.  gum  arabic, 

Pulv.  sacchar.  alb.,    aa.  Sss.  (Loaf  sugar.) 
Aqua,  menth.  pip.,  gxii.  (Peppermint  water.) 

Make  solution.  Dose. — Three  table-spoonsful  four 
times  a  day. 

^.    Co]iaiba3  balsam, 
Tinct.  cubebse, 
Tinct.  catechu, 
Sp.  getheris  nitrici,  aa. 
Tinct.  opii.  camph.,  giss. 
Pulv.  gum  arabic, 
Pulv.  sacchar.  alb.,  aa.  gss. 
Aquae  mentha,  Sivss.  Mix. 

Dose. — Table-spoonful  two  or  three  times  a  day. 
Capsules,  containing  copaiba  and  the  oil  of  cubebs,  have 
proved  very  useful  in  my  practice. 

Injections, 

fy.    Aquae  rosar,    giv.     (Rose  water.) 
Sulph  zinci,    grs.  x.  (White  vitriol.) 
Tinct.  opii,  3ss. 

Mix.    To  be  injected  several  times  a  day. 


588 


GONORRHEA. 


fy.    Aquae  rosar,  giv. 
Alum  et  pot.  sulph.,  grs.  x. 

Mix.    To  be  used  frequently. 

1^.    Aquae  destill.,  giv. 

Plumbi.  acet.,  9i.    (Sugar  of  lead.) 

Mix. 

Ify.    Zinci  sulph.,  (White  vitriol.) 

Plumbi  acet.,  aa.  9iss.  (Sugar  of  lead.) 
Aquae  destill.,  gviii. 

Solve,  filter  and  use  for  injection. 

E*.    Vini.  rub.,  Svi. 

.  .        .  ...  * 

Acidi  tannic,  grs.  xviii.  Mix. 

Tfy.    Aquae  destill.,  giv. 

Argent,  nit.,     grs.  i.  (Nitrate  of  silver.) 

Mix. 

Some  surgeons  employ  as  much  as  a  grain  to  the 
ounce.  If  a  very  powerful  effect  be  desired,  with  the 
view  of  cauterizing,  ten  to  thirty  grains  to  the  ounce  of 
water  may  be  used. 

• 

^.    Aquoe  destill.,  Siv. 

Ferri  iodidi,    grs.  ii.    (Iodide  of  iron.) 

Mix. 


The  quantity  of  iron  may  be  increased  to  as  much  as 
ten  grains  to  the  ounce  of  water,  but  as  there  is  danger 
of  irritation,  much  care  is  required. 


SYPHILIS. 


589 


I^.    Querci  cort.,  Sii.    (Oak  bark.) 
Aquge  Oj.  (Water.) 

Boil  down  to  half  pint,  strain  and  add  twenty  grains 
alum. 

Any  of  the  foregoing  injections  may  be  used  for  the 
vagina,  but.  generally  require  to  be  made  somewhat 
stronger. 

It  ought  to  be  observed  that  to  use  injections  most 
successfully,  they  should  be  employed  as  often  as  every 
hour  or  two.  There  is  almost  an  endless  variety  of 
them.  Those  which  I  have  found  to  be  the  most  useful, 
I  have  selected. 

SYPHILIS. 

The  Pox. — It  would  be  a  pleasing  task  to  us,  if  the 
character  of  our  work  would  admit,  to  enter  upon  and 
give  a  full  description  of  venereal  diseases,  their  nature 
and  history.  Our  work  being  entirely  practical,  we  will 
not  attempt  any  explanation  in  regard  to  the  history  or 
nature  of  this  disease,  yet,  in  the  language  of  a  distin- 
guished author,  we  cannot  refrain  from  presenting,  an 
instance  of  the  recent  introduction  of  this  disease,  which 
proves  emphatically  that  the  virus  is  not  spontaneously 
developed,  as  the  result  of  promiscuous  sexual  inter- 
course. ■  • 

"  The  island  Tahiti,  or  Otaheite,  the  principal  of  the 
group  of  the  Society  Islands,  in  Polynesia,  when  first 
discovered  by  Captain  Cook,  contained  a  population  of 
two  hundred  thousand  souls.  These  Islanders,  from 
their  personal  beauty  and  the  softness  of  their  manners, 
were  considered  as  among  the  most  interesting  people  of 
that  portion  of  the  globe.    At  the  same  time  they  were 


590 


SYPHILIS. 


so  voluptuous  in  their  habits,  and  so  free  and  promis- 
cuous in  their  amours,  that  the  first  French  navigators 
who  visited  the  island,  called  it  the  modern  Cytheria. 
Chastity  was  a  thing  unthought  of.  Hospitality  required 
every  Islander  to  offer  to  the  stranger  not  only  food  and 
shelter,  but  his  wife  or  his  daughter.  The  aristocracy 
of  the  island  had  formed  an  association  for  the  purpose 
of  encouraging  a  promiscuous  intercourse  of  the  sexes. 
With  all  this,  such  a  disease  was  never  heard  of,  until 
introduced  from  one  of  the  ships,  which  first  visited  this 
group.  It  soon  spread  over  the  island,  and  through  the 
whole  population.  This  beautiful  island — this  enchant- 
ing paradise  of  the  Southern  seas,  became  one  lazar- 
house  of  disease  and  death.  Under  its  destroying  influ- 
ence, the  population  was  gradually  diminished,  so  that 
there  now  exists  but  a  miserable  remnant  of  nine  thou- 
sand people,  and  many  of  these  are  sickly  and  deformed 
from  the  effects  of  this  disease.  They  are  wasting 
away.  The  fountains  of  life  are  drying  up — the  race  is 
withering  and  dying,  and  in  a  few  years  there  will  be 
scarcely  a  remnant  reserved  of  the  people  of  this  once 
populous  and  happy  island. 

When  the  English  missionaries  first  went  to  Tahiti, 
and  told  them  that  they  had  come  to  bring  them  joyous 
tidings  of  salvation,  the  chiefs  cried  out,  in  the  bitter- 
ness of  their  souls,  "  lies — lies  !  you  bring  us  death ;  we 
are  all  dying  of  your  accursed  diseases." 

Here,  then,  is  an  instance,  and  far  from  being  a  soli- 
tary one,  which  shows  that  syphilis  is  not  the  natural 
result  of  voluptuousness  and  promiscuous  sexual  inter- 
course, and  we  assert,  so  far  as  anything  is  known  of  its 
history,  it  has  always  been  propagated  by  contagion. 

When  it  first  appeared,  what  causes  produced  the 


SYPHILIS. 


591 


virus,  and  under  what  circumstances  it  was  developed, 
must  ever  remain  among  the  hidden  mysteries  which 
abound  in  pathological  science. 

This  terrible  disease  is  propagated  almost  exclusively 
during  the  act  of  venereal  intercourse,  though  I  am 
fully  satisfied  that  it  can  be  communicated  by  any  mode 
of  contact,  if  the  virus  is  caught  upon  an  eroded,  tender 
and  delicate  surface. 

Gonorrhea  and  syphilis  may  exist  at  the  same  time, 
and  may  be  confounded  together. 

When  the  surface  is  affected,  as  before  described,  it 
becomes  slightly  inflamed  in  about  twenty-four  hours ; 
on  the  second  or  third  day  there  is  a  slight  tumefaction, 
and  about  the  fourth  day  pustules  make  their  appear- 
ance ;  by  the  sixth,  these  pustules  form  into  a  crust ; 
under  these  crusts  is  found  an  ulcer,  with  a  red  surface 
and  elevated  margin.  The  parts  most  exposed  and 
those  most  frequently  affected,  are  the  glans  penis  and 
prepuce.  It  is  asserted  by  respectable  authority,  that 
those  whose  glans  are  habitually  covered  by  the  prepuce, 
are  more  liable  to  contract  the  disease,  than  those  in 
whom  that  part  has  more  of  a  cutaneous  surface,  from 
being  uncovered. 

When  the  disease  is  strictly  local  in  its  character,  it 
is  termed  primary  syphilis.  Where  it  begins  to  mani- 
fest itself  in  other  parts  (the  gradual  result  of  the  local 
affection)  it  is  then  termed  secondary  syphilis.  We 
have  again,  a  recurrence  of  these  or  worse  symptoms 
"  after  the  secondary  has  been  cured."  This  has  been 
termed  tertiary  syphilis.  A  physician  who  has  had 
much  experience  in  this  class  of  disease  says,  that  during 
the  progress  and  continuance  of  the  syphilitic  chancre, 
the  venereal  poison  appears  to  be  produced  and  absorbed 


592 


SYPHILIS. 


into  the  system,  producing  as  the  next  most  common 
symptom,  an  enlargment  of  the  glands,  termed  buboes. 
These,  when  caused  by  the  absorption  of  the  virus,  and 
having  suppurated  and  opened,  form  deep  seated  syphi- 
litic ulcers,  producing  the  virus  capable  of  communica- 
ting the  disease  by  inoculation.  This  is  the  most 
ordinary  method  of  producing  primary  syphilis ;  but  it 
is  evident  that  the  virus,  wherever  applied,  will  cause, 
under  certain  circumstances,  its  specific  effects.  Thus, 
the  lips,  the  tongue,  the  eyelids,  the  nipple,  or  any  ten- 
der or  eroded  spot  upon  the  body,  may  be  the  seat  of 
the  chancre. 

"  The  first  breaking  out  of  secondary  or  constitutional 
syphylis  may  take  place  in  ten  days  or  it  may  not 
appear  for  months  or  even  years,  depending  apparently 
upon  the  temperament  of  the  patient.  It  is  usually 
characterized  by  ulceration  of  the  fauces,  (throat) 
destruction  of  the  uvula,  (palate)  and  spongy  bones  of 
the  nose,  pimple  eruptions  of  the  breast,  extensive  ulce- 
ration over  the  shoulder  blade,  on  the  elbow  and  other 
surfaces  lying  near  the  bones,  nodes  (protuberances  or 
ridges)  upon  the  superficial  bones,  mucous  tubercles,  and 
a  great  variety  of  diseases  of  the  skin. 

"  It  is  asserted  that  the  syphilitic  virus  contained  in 
secondary  ulcers  will  not  produce  the  primitive  affection 
or  chancre  by  inoculation,  but  it  may  be  transmitted 
from  parent  to  child,  from  husband  to  wife,  and,  per- 
haps, also  from  the  infant  to  the  nurse,  and  from  the 
nurse  to  other  infants.  This  poison  may  lie  dormant  in 
the  system  for  months  or  even  years,  or  without  appear- 
ing in  the  individual,  may  be  the  curse  of  his  or  her 
posterity. 

"  If  the  secondary  smyptoms  should  not  be  checked 


syphilis.  593 

early,  the  disease  will  make  rapid  progress,  the  testicles 
become  swelled  and  hardened,  excrescences  appear  about 
the  anus,  the  hair  falls  from  the  head,  the  eyes  are 
blinded,  the  ears  deafened,  the  bones  swell,  exfoliate, 
and  rot  away  in  deep  seated  ulcerations,  the  bones  of  the 
face  are  destroyed,  the  skull  becomes  eaten  in  holes  like 
a  honey-comb,  or  falls  away  from  the  brain,  and,  finally, 
the  patient  dies  the  most  horrible  and  disgusting  of 
deaths." 

I  shall  now  proceed  to  the  particular  description  and 
treatment  of  syphilis  in  its  first  and  primary  stage, 
with  all  of  its  complications.  And  before  entering 
on  this  portion  of  my  subject,  I  may,  in  the  language 
of  one  who  has  written  extensively  upon  this  subject 
assert,  that  no  chemical  or  medical  agent  is  now 
known  to  the  profession  which  can  be  at  all  relied  upon 
as  a  specific  antidote  to  the  primary  symptoms  of 
syphilis. 

The  first  stage  is  well  marked;  it  secretes  matter 
of  a  contagious  character,  and  manifests  itself  in  a 
slight  itching,  where  a  redness  is  soon  discovered, 
this  soon  becomes  a  pimple  or  pustule,  changing  its 
red  to  that  of  a  yellow  or  copper  color,  afterwards 
bursts,  presenting  you  with  a  chancre.  These  chancres 
sometimes  exist  so  superficial  as  not  to  destroy  the  entire 
thickness  of  the  skin.  Their  progress  in  general  is 
limited  by  the  disposition  of  plastic  lymph  which  forms 
the  characteristic  induration ;  there  are  other  varieties 
which  spread  over  the  surface  in  a  ring-like  manner ;  the 
depth  of  this  variety  of  chancre  bears  no  proportion  to 
its  surface.  If  a  sore  makes  its  appearance  about  the 
organs  of  generation,  especially  if  it  follows  a  suspicious 
sexual  connection,  then  you  have  strong  reasons  to  sup- 
38 


594 


SYPHILIS. 


pose  that  it  is  syphilitic,  and  there  is  no  room  to  doubt  if 
in  due  time  it  should  be  followed  by  a  bubo.  I  cannot 
do  better  in  the  second  or  declining  stage  than  to  give 
you  a  quotation  from  one  who  has  had  ample  experi- 
ence, who  says,  when  the  chancre  has  become  a  simple 
ulcer,  it  is  believed  to  have  entirely  lost  its  power  of 
communication  to  others,  and  contends  that  the  chancre 
in  its  first  or  characteristic  stage  is  an  ulcer,  the  cha- 
racter of  which  I  have  described,  yet  irritable  to  the 
touch,  and  having  a  tendency  to  spread,  or  burrow,  and 
destroy  the  parts  as  it  goes.  It  has  raised  and  ragged 
edges,  and  commonly  an  indurated  base,  with  a  tume- 
faction of  the  surrounding  parts,  this  swelling  appearing 
somewhat  regularly  circumscribed  and  movable  like  a 
bullet.  When  the  ulcer  is  located  on  the  prepuce  or 
frsenum,  this  hardness  is  wanting,  and  we  have  instead 
a  more  diffused  inflammation,  with  greater  painfulness. 
The  pus  of  the  chancre  is  of  a  corroding  character,  and 
may  produce  a  similar  ulceration  on  any  part  it  comes 
in  contact  with.  The  period  of  the  appearance  of  the 
chancre  after  infection,  varies  from  twenty-four  hours 
to  several  weeks.  A  few  days  is  the  most  common  term ; 
it  has  been  known  in  rare  instances  to  extend  to  several 
months. 

The  constitutional  or  secondary  symptoms  of  the  dis- 
ease, usually  first  develope  themselves  after  the  lapse  of 
a  few  months,  in  the  mucous  membrane  of  the  throat, 
mouth,  or  nose,  blotches  on  the  skin  sometimes  precede 
or  accompany  these  mucous  affections.  The  periosteum 
(the  membrane  covering  the  bones)  is  next  implicated. 
You  have  a  dull,  heavy  aching  pain  generally  manifest- 
ing itself  about  night,  accompanied  with  tenderness  and 
swellings  of  the  more  exposed  bones. 


SYPHILIS. 


595 


Buboes  or  swellings  of  the  inguinal  glands  are  among 
the  most  common  symptoms,  coming  on  soon  after  the 
chancre,  and  generally  in  proportion  to  the  amount  of 
irritation  in  surrounding  parts.  If  the  virulence  of  the 
disease  is  not  soon  lessened  these  swollen  glands  will 
inflame  and  ulcerate,  which  are  frequently  quite  obsti- 
nate in  their  character.  Swellings  of  the  groin,  however, 
are  by  no  means  peculiar  alone  to  the  syphilitic  virus. 
They  frequently  arise  from  gonorrhea  or  any  irritation 
about  the  genitals;  they  result  oftentimes  from  injuries 
of  the  foot.  Therefore,  without  other  evidence  of  the 
disease  in  question,  we  should  regard  buboes  as  probably 
arising  from  other  causes.  But  if  syphilis  has  preceded 
and  been  apparently  cured,  the  buboes  still  remaining  or 
reappearing  without  other  sufficient  cause,  they  are  to 
be  looked  upon  as  positive  evidence  of  syphilitic  virus 
still  remaining  in  the  system. 

When  the  throat  is  the  part  affected  the  ulcerated, 
appearance  is  usually  first  noticed  upon  the  tonsils. 
Secondary  ulcers  frequently  appear  on  different  parts 
of  the  body,  and  these  are  sometimes  replaced  by  a  sort 
of  chronic  nettle-rash  spread  over  the  whole  surface, 
accompanied  with  periodical  pains,  especially  in  the 
bones. 

There  is  quite  a  variety  of  chancres,  such  as  the  dip- 
theretic,  serpignous,  and  the  gangrenous;  these  varieties 
may  be  complicated  with  each  other,  and  the  same 
chancre  may,  in  different  parts,  exhibit  different  appear- 
ances. 

We  have  indulged  already  upon  this  subject  farther 
than  the  character  of  our  work  indicates,  much  more 
could  be  said,  and  appropriately,  in  regard  to  the  com- 
plications and  new  ulcerations  which  are  liable  to  be 


596 


SYPHILIS. 


produced  wherever  the  virus  comes  in  contact  with  a 
denuded,  tender,  or  pervious  surface. 

The  diagnosis  is  not  generally  difficult  if  you  can  trace 
the  symptoms  to  an  infection,  and  recollect  that  secon- 
dary symptoms  must  always  have  been  preceded  by 
primary.  Prognosis  of  chancre  in  its  simplest  form,  and 
unattended  with  the  aggravations  and  complication  above 
described,  is  regular  and  simple.  In  a  good  constitution 
with  temperate  habits  it  begins  as  a  pustule,  an  abscess, 
or  excoriation,  it  becomes  an  ulcer,  its  progress  is  stayed 
by  an  extravisation  of  lymph ;  it  takes  on  the  reparative 
stage;  granulations  form,  and  cicatrization  follows  in 
from  three  to  five  weeks.  This  is  the  natural  and 
regular  course  of  the  primary  syphilitic  ulcer.  But  in  a 
majority  of  cases  we  must  not  look  for  results  so  favor- 
able. 

Treatment. — Your  first  great  object  must  be  to  form  a 
correct  diagnosis ;  it,  in  many  cases,  is  extremely 
difficult  to  distinguish  sores  which  are  not  virulent  from 
those  of  the  chancre,  and  where  *you  have  any  doubts 
inoculation  is  the  only  sure  guide  to  a  correct  diagnosis. 
"  This  is  a  test,  however,  which  patients  are  not  always 
willing  to  submit  to,  yet  few  intelligent  persons  would 
object  were  the  nature  of  the  experiment  properly  ex- 
plained. I  say,  here  is  a  pustule,  or  ulcer,  as  the  case 
may  be,  in  a  suspicious  situation,  and  the  result  of  a 
suspicious  connection,  perhaps,  it  is  probably  syphilitic, 
but  possibly  not.  If  it  is  not  it  would  do  you  no  kind 
of  harm  for  me  to  take  some  of  its  matter  on  the  point 
of  my  lancet,  and  prick  the  inside  of  your  thigh.  I  shall 
treat  the  first  sore  as  if  it  were  a  chancre,  and  if  it  prove 
to  have  been  one  by  the  production  of  the  second,  I  have 
but  to  remove  that  in  the  same  manner,  and  follow  up 


SYPHILIS. 


597 


their  cure  with  such  constitutional  treatment  as  may 
prevent  the  appearance  of  the  dreaded  secondary  symp- 
toms. Should  nothing  result  from  the  inoculation,  of 
course  no  preventive  treatment  would  be  necessary,  and 
the  patient,  if  he  have  the  proper  confidence  in  your 
skill,  will  be  relieved  from  all  apprehension." 

The  cases  generally  are  not  presented  sufficiently 
early  to  attempt  their  sjDeedy  eradication  by  what  I  may 
term  the  abortive  treatment.  Your  first  indication  will 
be  to  check,  as  speedily  as  possible,  the  formation  of  the 
syphilitic  virus.  Two  modes  have  been  pointed  out  to 
effect  this  object — excision  and  cauterization — and  it  is 
frequently  a  more  thorough  practice  to  combine  the 
two.  I  believe  that  where  a  virulent  chancre  presents 
itself  upon  the  prepuce,  if  it  is  not  too  extensive,  that 
the  most  speedy  cure  will  be  effected  by  cutting  it  away, 
and  afterwards  cauterizing  the  wound  with  caustic  pot- 
ash. And  it  is  a  rule  in  my  practice,  and  one  that  I 
seldom  deviate  from,  that  whenever  a  patient  presents 
himself  with  any  lesion  or  abrasion  after  a  suspicious 
connection,  I  cauterize  it  without  hesitation,  without 
waiting  to  see  the  result  of  either  lesion  or  abrasion. 

If  you  have  a  chancre  or  secondary  ulcers  they  should 
be  washed  frequently  in  strong  soap  suds,  or  a  weak 
solution  of  the  sesqui-carbonate  of  potash.  We  do  not 
wish  to  be  understood  that  the  mere  destruction  of  the 
sore  or  chancre,  will  prevent  the  further  developement 
of  the  infection.  I  cannot,  in  the  language  of  a  distin- 
guished author,  assert,  that  the  system  is  impregnated 
with  the  virus,  producing  constitutional  effects  immedi- 
ately after  the  connection.  But,  on  the  contrary,  I  am 
rather  of  the  opinion,  that  the  virus  makes  its  way  gra- 
dually into  the  system,  and  that  the  malignancy  of  the 


598 


SYPHILIS. 


chancre  is  a  local  symptom,  the  result  of  this  impregna- 
tion. An  author  of  some  celebrity  advises  a  strong 
solution  of  the  bi-  or  sesqui-carbonate  of  potash,  to  be 
applied  to  the  ulcers  as  I  have  before  directed,  after 
which  he  advises  a  plaster  to  be  applied  of  the  inspissa- 
ted juice  of  the  phytolacca  decandra,  (Poke  root.)  If 
this  poke  plaster  be  used,  it  should  be  changed  twice  a 
day.  To  correct  the  foetor,  a  few  days  application  of 
pyroligneous  acid  will  suffice.  A  good  lotion  may  be 
found  in  a  strong  decoction  of  the  epifagous  virginia- 
nus,  (beech  drops,)  especially  if  the  sore  is  inclined  to 
assume  the  irritable  form.  Another  is  made  of  the 
corydalis  formosa;  it  is  sometimes  called  turkey  corn, 
wild  turkey  pea,  and  stagger  weed ;  it  is  a  good  local 
application,  and  a  valuable  remedy,  and  as  far  as  my 
information  extends,  it  is  only  used  by  the  eclectic  prac- 
tioners.  It  is  peculiarly  valuable  in  syj)hilitic  affec- 
tions. From  one  to  four  ounces  of  the  decoction  is  given 
three  times  a  day,  or  from  a  drachm  to  two  drachms  of 
the  saturated  tincture. 

"Whenever  the  chancre  presents  a  healthy  appearance 
we  generally  dress  it  with  the  black  salve,  the  prescrip- 
tion of  which  we  have  heretofore  given;  or  if  the 
chancre  has  a  fungus  tendency,  and '  seems  to  be  indo- 
lent in  its  action,  we  advise,  the  application  of  the  fol- 
lowing salve : 

EL.    Eosin,  Sviii. 
Beeswax,  Siv. 
Lard,  Svi. 
Verdigris,  ground  in  oil,  thick  as  tar,  gss. 

Melt  all  together,  and  stir  until  cold,  and  apply  as 
advised  with  the  black  salve. 


SYPHILIS. 


599 


A  physician  of  much  experience  condemns  greasy  sub- 
stances and  mercurial  ointment  as  local  applications  to 
chancres,  contending  that  simple  poultices  and  fomenta- 
tions, with  the  dressings  of  aromatic  wine,  and  an  aqueous 
solution  of  opium  answer  better  where  there  is  much  pain. 

Others  extol  the  black  and  yellow  wash,  or  a  solution 
of  the  bi-chloride  of  mercury.  All  these  applications 
may  be  very  beneficial,  but  there  are  none  equal  to  the 
cauterization  I  have  heretofore  advised. 

We  have  certainly  said  sufficient  in  regard  to  local 
treatment ;  this  should  never  be  neglected,  but  at  the 
same  time  we  should  administer  constitutional  remedies 
as  a  guard  against  the  progress  of  the  disease,  and  the 
development  of  secondary  symptoms.  There  are  a  great 
variety  of  opinions  in  regard  to  what  the  constitutional 
remedies  should  be  in  this  disease ;  some  advocate  mer- 
cury, others  condemn  it ;  some  have  carried  their  senti- 
ments to  such  extent,  as  to  say,  "  if  syphilis  is  an  oppro- 
brium to  the  human  race,  mercury  is  no  less  so  to  the 
medical  profession.  The  medicine  is  now,  at  least,  a  far 
more  extensive  scourge  than  the  malady."  Some  go  so 
far  as  to  assert  that  mercury  is  a  specific  for  syphilis ;  I 
shall  not  myself  offer  any  theory  upon  the  subject,  but 
if  such  be  the  fact,  in  my  own  opinion,  I  must  regret 
that  a  more  absolute  and  certain  specific  has  not  been 
found.  Prejudices  may,  and  have  indeed  opposed  its 
administration ;  it  was  at  one  time  almost  universally 
used,  but  at  the  present  time,  my  convictions  are,  that 
in  this  disease  it  must  be  used  or  avoided,  according  to 
its  effects.-  In  some  cases,  it  evidently  aggravates  the 
symptoms ;  in  others,  it  seems  indispensable  to  a  cure ; 
those  who  use  this  latter  remedy,  generally  prefer  the 
proto  iodide,  the  blue  pill,  or  Plummer's  pill,  until  the 


600 


SYPHILIS. 


gums  are  slightly  affected;  of  late,  we  have  seldom 
relied  upon  this  form  of  constitutional  treatment,  but 
have  employed  one  diametrically  opposite,  in  which 
we  substitute  podophylline  for  mercury,  believing  that 
it  exerts  almost  the  same  specific  influence  over  the 
secretions  as  the  former.  We  have  the  bowels  kept 
in  a  soluble  condition,  and  to  effect  this  purpose, 
we  give  the  iris  versicolar,  (blue  flag,)  or  the  iodine, 
combined  with  podophylline ;  or  we  take  one-fourth  a 
grain  of  podophyllin  and  combine  with  it  six  grains  of 
the  extract  of  the  phytolacca  decandra,  (poke  root,)  and 
give  this  quantity  night  and  morning,  continuing  ac- 
cording to  circumstances. 

Dr.  Hill  says,  and  his  opinion  is  entitled  to  much 
consideration,  that  our  common  alterative  syrup,  which 
is  the  roots  of  the  Honduras  sarsaparilla,  yellow  parilla, 
burdock,  and  ground  guaiacum  wood,  each  ten  ounces 
avoirdupois ;  bark  of  the  root  of  sassafras,  elder  flowers, 
blue  flag  root,  each  eight  ounces  avoirdupois,  we  add 
one  ounce  of  the  hydriodate  of  potassse  to  every  quart 
and  a  half  of  syrup.  This  preparation  is  prepared  in 
the  Eclectic  Dispensatory  as  follows  : — Grind  and  mix 
the  articles  together,  place  the  whole  four  pounds  in  a 
convenient  vessel ;  cover  them  with  alcohol  of  76  per 
cent.,  and  macerate  for  two  days;  then  transfer  the 
whole  to  a  common  displacement  apparatus,  or  pecu- 
lator, and  gradually  add  hot  water,  until  two  pints  have 
been  obtained,  which  retain  and  set  aside. 

2.  Then  continue  the  percolation,  and  of  the  second 
solution  reserve  so  much  as  contains  a  sensible  amount 
of  spirit,  and  distill  or  evaporate  the  alcohol  from  it. 

3.  Continue  the  displacement,  by  hot  water,  until  the 
solution  obtained  is  almost  tasteless,  and  boil  down  this 


SYPHILIS. 


G01 


weaker  infusion  till  it  begins  to  thicken,  or  until,  when 
added  to  the  balance  remaining  of  the  second  portion, 
after  the  evaporation  of  the  alcohol,  it  will  make  twelve 
pints. 

4.  To  these  two  solutions  combined,  add  sixteen 
pounds  of  refined  sugar,  and,  by  heat,  dissolve  carefully, 
removing  the  scum,  which  arises  as  it  comes  to  the  point 
of  boiling.  Then,  if  it  exceeds  that  quantity,  evaporate 
the  syrup  with  constant  stirring,  to  fourteen  pints,  re- 
move from  the  fire,  and,  when  nearly  cold,  add  the  two 
pints  of  tincture  first  obtained,  and  make  two  gallons  of 
syrup.  Each  pint  will  contain  the  virtues  of  four 
ounces  of  the  ingredients.  It  will  be  well  to  add  to  it 
as  much  of  the  phytolacca  as  can  be  borne  by  the  pa- 
tient. A  wine-glassful  three  or  four  times  a  day.  He 
says,  a  syrup  of  the  article  last  named,  with  iris  versico- 
lar  (blue  flag)  and  pelopsus  quinque  folia,  (woodbine, 
or  wild  wood  vine,)  equal  parts  of  the  whole,  will,  in 
many  cases,  prove  sufficient,  with  the  other  means  re- 
commended, to  eradicate  every  trace  of  the  disease. 

The  corydalis  formosa  (turkey  corn)  has  often  proved 
a  specific  in  the  worst  cases ;  it  should  be  given  in  sub- 
stance of  six  grain  doses,  using  a  strong  decoction  of  the 
same  article  as  a  wash  for  the  ulcers.  A  remedy  which 
is  considered  the  most  reliable  antidote  to  the  syphilitic 
poison,  is  the  stillingia  sylvatica;  (queen's  delight)  it 
should  be  taken  either  in  the  form  of  a  syrup,  or  a  strong 
decoction,  to  the  extent  of  producing  nausea  or  actual 
vomiting,  as  often  as  once  every  three  or  four  days,  con- 
tinuing it  in  more  moderate  quantities,  three  or  four 
times  a  day  in  the  intervals. 

During  the  whole  course  of  this  vegetable  treatment 
the  alkaline  bath  should  be  indulged  in  freely.    If,  on 


602 


SYPHILIS. 


the  other  hand,  you  resort  to  the  mercurial  plan  of  treat- 
ment, you  must,  during  the  reparative  stage  of  the 
chancre,  and  as  long  as  any  hardness  continues,  the  use 
of  mercurial  dressings  and  frictions  around  the  part 
affected,  with  a  mild  mercurial  course  of  constitutional 
treatment,  must  be  persevered  in.  When  induration 
takes  place  in  a  simple  chancre,  the  caustic  must  be 
abandoned,  and  the  French  surgeons  recommend  iodine 
in  combination  with  proto  iodide  of  mercury.  Bicord 
gives  it  in  one  grain  doses  in  combination  with  henbane, 
every  night  in  a  pill  five  hours  after  the  last  meal ;  after 
this  remedy  has  been  taken  for  a  week,  the  dose  can  be 
increased  to  a  pill  every  night  and  morning. 

Whilst  upon  the  subject  of  primary  syphilis,  the  treat- 
of  buboes  will  require  some  special  notice.  We  have  told 
you  that  they  are  not  always  the  result^  of  syphilitic 
virus,  but  wherever  you  find  them  in  connection  with 
this  disease,  you  will  have  hardened  tumors  in  the  groin, 
slightly  painful  and  tender  to  the  touch.  A  bubo  ought, 
if  possible,  to  be  prevented  from  advancing  to  suppura- 
tion. Prompt  measures  should  be  taken  to  scatter  them. 
In  this  stage  they  may  be  discussed.  Ice  or  cold  water 
and  compression  have  been  found  useful  in  dissipating 
the  swelling  which  had  commenced ;  a  reclined  position 
in  combination  with  the  general  antiphlogistic  regimen, 
will  materially  aid  the  application.  If  this  should  fail 
try  an  application  of  fine  salt  moistened  with  turpentine, 
or  the  parts  may  be  wet  three  or  four  times  a  day  with 
gum  camphor  dissolved  in  spirits  of  turpentine.  Some 
contend  that  the  saturated  tincture  of  poke  root  will 
often  be  sufficient;  some  recommend  a  thick  plaster 
of  mercurial  ointment  to  be  used  over  the  indolent 
glands.    Should  these  disentient  means  not  be  success- 


SYPHILIS. 


603 


ful,  warm  fomentations,  frequently  changed,  or  cloths 
dipped  in  hot  water,  or  poultices,  may  prove  more 
effectual.  To  assist  and  promote  suppuration  we  have 
taken  equal  portions  of  vinegar  and  laudanum  and 
used  it  warm  by  saturating  a  flannel  rag,  and  keep- 
ing it  constantly  applied.  When  the  glands  show 
the  least  fluctuation,  not  a  moment  should  be  lost 
after  the  appearance  of  pus  before  it  is  opened  to  allow 
its  escape.  Otherwise  the  abscess  would  extend  itself, 
and  all  the  pus  absorbed  is  so  much  virus  carried  into 
the  system. 

Some  recommend  opening  the  buboes  by  making  small 
issues  with  caustic  potash;  we  prefer  the  lancet  to 
caustics.  The  incision  should  be  made  sufficiently  ex- 
tensive, and  lengthwise  of  tile  tumor.  The  pus  should 
be  removed  as  soon  as  possible,  the  part  to  be  washed 
frequently  in  soap-suds,  in  connection  with  a  weak  solu- 
tion of  the  sesqui-carbonate  of  potash ;  this  should  be 
continued  until  healing  is  effected.  In  regard  to  the 
mercurial  course  of  treatment,  I  incline  to  the  opinion 
that  it  is  a  preventive  medicine  against  secondary  symp- 
toms ;  farther  than  this  I  cannot  go.  I  am  satisfied  that 
mercury  produces  certain  effects ;  by  what  means  it  acts 
in  preventing  secondary  symptoms,  I  confess  I  do  not 
know.  Quackery  consists  in  pretending  to  more  know- 
ledge and  ability  than  we  possess. 

"  The  physician  whose  practice  in  the  army  of  Mex- 
ico was  referred  to  under  gonorrhea,  had  also  an  exten- 
sive experience  in  the  treatment  of  6  primary  syphilis/ 
or  of  that  disease  in  the  first  stage  after  infection.  He 
reports  the  following  as  his  most  successful  practice.  To 
the  chancre,  when  it  first  appeared,  he  applied  a  mild 
escharotic,  such  as  our  sesqui-carbonate  of  potash,  and 


SYPHILIS. 


afterwards,  when  he  had  used  up  his  supply,  and  could 
procure  no  more  in  the  army  or  the  country,  (he  might 
easily  have  prepared  it  himself)  the  sulphate  of  zinc 
was  used  instead.  An  hour  or  so  after  the  first  applica- 
tion of  one  or  other  article  in  powder,  a  solution  of  the 
same  was  freely  applied  as  a  wash.  The  glands  and 
the  inside  of  the  prepuce  were  treated  in  the  same  way. 
The  patients  were  also  made  to  wash  the  parts  three  or 
four  times  a  day  in  warm  soap-suds.  After  each  wash- 
ing, the  surface  of  the  sore  was  freshly  dressed  with 
Turner's  Cerate."    (U.  S.  Dispensatory.) 

No  other  internal  remedy  was  prescribed,  than  the 
same  cholagogue  purgatives  mentioned  as  given  for 
gonorrhea.  (Refer  to  the  quotation  under  that  article.) 
These  were  taken  three  times  a  week,  unless  the  "  local 
disease"  manifested  a  disposition  to  spread  beyond  the 
original  seat  of  the  chancre,  and  involve  the  prepuce 
and  parts  below  the  glands.  In  that  case,  alterative 
closes  of  podophyllum  and  iris  versicolar  were  given, 
just  sufficient  to  keep  the  bowels  a  little  loose  ;  and  the 
powdered  caustic,  also,  was  then  resorted  to  more  freely 
and  frequently.  If  phimosis  or  paraphimosis  came  on, 
the  prepuce  being  much  inflamed,  fomentations  of  ele- 
campane and  sassafras  were  resorted  to,  and  the  parts 
washed  with  infusions  of  the  same  articles. 

After  the  sore  assumed  a  healthy  appearance,  which 
he  states  would  generally  happen  in  the  course  of  four 
or  five  days,  simple  dressings  only  were  applied ;  and  in 
about  twice  that  time,  or  less  than  two  weeks  after  the 
treatment  was  commenced,  the  worst  cases  yielded 
entirely.  This,  it  ought  to  be  borne  in  mind,  was  in  a 
warm  climate,  where,  it  is  well  known,  the  disease  is 
always  milder  and  more  easily  cured. 


SYPHILIS. 


G05 


Those  mercurial  preparations  that  are  relied  on  for 
this  disease,  we  have  selected  and  classified  as  follows : 

pais. 

fy.  Hydrarg.  bichlorid,  grs.  ii.  (corrosive  sublimate.) 
Solve  in  aqua  destil.,  q.  s.  (diss,  in  dist'ld.  water.) 
Opii,  grs.  ii. 

Mellis,  grs.  xx.  (honey.) 

Micae  panis,  q.  s.  (bread  crumbs.) 

Made  into  40  pills. 

This  is  a  formula  of  which  the  Germans  entertain  a 
very  high  opinion.  Hufeland  says  that  corrosive  subli- 
mate may  be  used  without  detriment,  and  for  a  long- 
time, if  given  in  pills  united  with  a  mucilaginous  vehicle, 
in  order  that  it  may  dissolve  slowly,  which  prevents 
nausea,  colic  and  diarrhoea.  It  is  proper  to  remark,  he 
adds,  that  corrosive  sublimate  is  apt  to  affect  the  lungs, 
and  therefore,  in  persons  of  a  phthisical  disposition,  is 
contra-indicated.  The  dose  of  the  pills  is  six,  ten,  and 
even  twelve,  morning  and  evening. 

^.    Hydrarg.  proto  chlorid., 

Antimonii  sulph.  precip.,  aa.  5i. 
Guaici  resinse  pulv.,  5n\ 
Syrupi,  oi. 

F.  M.  Divide  in  pills  of  five  grains  each,  and  give 
one  two  or  three  times  a  day.  It  may  be  useful,  if  they 
act  too  freely  on  the  bowels,  to  combine  one-fourth  of  a 
gram  of  opium  with  each  pill. 

Decoctions. 
Decoctum  Mezereum. 
1^.    Ead.  Mezerei,  (spurge  olive.) 

Had.  Glycyrrhizae,  Sss.  (liquorice  root.) 
Aquae,  lb.  iii.  (water.) 


GOG  SYPHILIS. 

Boil  with  a  gentle  fire,  down  to  two  pounds,  and 
strain.  In  nodes  and  pains^  this  is  very  useful.  The 
dose  is  from  four  to  eight  fluid  ounces,  three  times  a  day. 

Solutions. 

^.    Aqua3,  Bviii.  (Water.) 

Amruonise  Hydrochl.,  oil.  (Muriate  of  ammonia.) 

Solve.  Particularly  useful  in  resolving  the  inflamma- 
tion and  swelling  of  buboes. 

Aquas  destill.,  giii. 
Tinct.  iodini,  3i.  Mix. 

This  tincture  may  be  made  stronger  if  desirable.  It 
is  employed  in  the  treatment  of  buboes,  hydrocele,  &c. 

Vinum  Aromaticum  et  Ojpii. 

I^.    Villi  aromaticii,        gviij.    (Aromatic  wine.) 
Ext.  Opii.,  5ss.  Solve. 

Employed  as  dressings  for  chancres  and  buboes. 

Gargles. 

fy.    Plumbi  acetatis,  3j.    (Sugar  of  lead.) 

Syrupi  simpl.,  %j.    (Simple  syrup.) 

Decoct,  hordei,  lb.j.  (Decoction  of  barley.) 

Make  into  solution.    Useful  in  mercurial  sore  mouth. 

^.    Zinc  sulph.  3ij.    (White  vitriol.) 

Mellis,  Sj-  (Honey.) 

Tinct.  Myrrhaa,  By. 

Spirit  vini  gallici,  By. 

Aquae  rosarum,  Bvj. 


SYPHILIS. 


607 


Make  into  solution.  Useful  as  a  gargle,  to  be  used 
occasionally,  when  there  is  excessive  salivation. 

Corrosive  Sublimate  and  Lime  Water. 
^.    Hydrarg.  bi-chlorid.  gr.  j. 

Aquse  calcis,  Sj- 

Make  into  solution.  This  may  be  advantageously 
employed  in  venereal  ulcers  of  the  throat. 

Dr.  King  says :  "  For  several  years  past,  I  have  used 
this  article  as  an  application  to  chancre,  in  hundreds  of 
instances,  and  as  yet  have  not  heard  of  any  return  of 
the  disease,  either  in  a  secondary  or  tertiary  form.  It 
is  to  be  applied  while  the  chancre  is  in  the  pustular 
form,  and  unbroken,  and  before  the  virus  is  acted  upon 
by  the  oxygen  of  the  atmosphere,  and  absorbed  into 
the  system.  As  soon  as  the  pustule  is  discovered,  the 
physician  will  open  it,  and  apply  several  drops  of  nitric 
acid  to  it,  thus  destroying  the  virus  at  once,  and  curing 
the  disease  in  a  few  minutes.  The  pain  occasioned  is 
hardly  noticed  by  some  patients.  Sometimes  I  wash 
the  ulcer,  subsequently,  with  the  muriated  tincture  of 
iron.  No  other  treatment  is  required  unless  for  the 
purpose  of  allaying  the  patient's  fears.  My  colleague, 
Professor  K.  S.  Newton,  whom  I  informed  of  the  success 
following  this  course,  has  likewise  effectually  tested  its 
utility  in  numerous  cases." 

A  combination  of  iridin,  (blue  flag,)  podophyllin, 
(mandrake,)  and  xanthoxylin,  is  a  most  powerful  and 
certain  remedy  for  syphilis,  either  primary  or  secondary. 


608 


SCROFULA. 


SCROFULOUS  DISEASES, 

SCROFULA,  OR  KING'S  EVIL. 

This  disease  most  generally  makes  its  appearance  be- 
tween the  third  and  seventh  year  of  age ;  and  all  of  the 
absorbent  glands,  whether  situated  external  or  internal 
are  liable  to  inflammation ;  and  if  there  is  a  scrofulous 
predisposition,  they  are  liable  to  scrofulous  inflamma- 
tion. 

The  term  scrofula  is  used  very  latitudinous  by  many 
authors,  applying  it  to  almost  every  morbid  affection 
of  the  system;  this,  in  my  judgment,  is  not  correct, 
and  the  term  is  generally  applied  too  extensively  for 
practical  purposes. 

Some  authors  assert,  that  it  most  commonly  affects 
children  of  a  lax  habit,  with  a  smooth,  soft,  and  fine 
skin,  fair  hair,  rosy  cheeks,  and  a  delicate  complexion, 
but  it  is  occasionally  met  with  in  those  of  a  dark  one. 

M.  Lugal,  whose  opinion,  I  confess,  corresponds  with 
my  own,  as  far  as  my  observation  has  extended,  says,  few 
persons  who  are  scrofulous  have  light  hair;  in  more  than 
half  of  them  the  hair  is  dark ;  among  the  others,  most 
of  them  have  chestnut  hair,  which  is  of  a  dark,  more 
commonly  than  a  light  chestnut  color.  The  same  re- 
marks apply  to  the  color  of  the  eyes,  and  also  to  that 
of  the  skin,  which  is  dark  more  frequently  than  light. 
This  color  of  the  hair  may  be  explained  partially  by  the 
age  of  our  patients ;  they  are  generally  from  fifteen  to 
twenty  years  old.  In  fact,  we  know  that  the  color  of 
the  hair  becomes  darker  as  children  grow  up,  and  that 
where  it  is  very  light  in  the  early  years  of  childhood,  it 


SCROFULA. 


609 


generally  changes  to  chestnut  of  different  shades,  as 
years  progress,  and  is  sometimes  black  at  puberty. 
These  general  remarks,  which  are  so  contrary  to  all 
that  has  been  written  on  the  color  of  the  hair,  the  eyes 
and  skin  of  scrofulous  patients,  may  be  verified  daily  in 
my  ward  in  the  hospital  at  St.  Louis. 

You  will  perceive  that  scrofulous  constitutions  present 
many  differences,  and  there  may  be  a  tendency  to  a 
scrofulous  diathesis,  ranging  from  the  highest  degree  it 
can  attain,  to  that  where  it  is  the  least  distinct.  But, 
however  much  it  may  vary,  it  is  very  easy  to  be  re- 
cognized in  most  cases ;  and,  in  fact,  in  a  very  large 
majority  of  cases,  the  constitution  of  scrofulous  children 
is  so  marked  that  it  is  scarcely  necessary  to  be  a  physi- 
cian to  detect  it.  It  is  essential  to  the  physician  to 
have  a  proper  and  correct  knowledge  of  scrofulous  con- 
stitutions. An  author  upon  this  subject,  of  much  celeb- 
rity, says  that  scrofulous  families  are  recognized  by  a 
general  mark  of  debility,  (I  have  seen  myself  many 
cases  of  this  character,)  which  is  seen  in  all  the  chil- 
dren. A  scrofulous  constitution  permits,  at  most,  a 
negative  state  of  health  with  some,  and  indicates  a  want 
of  stre'ngth  and  good  organization. 

In  their  physical  formation,  children  of  this  peculiar 
character  are  not  symmetrical ;  the  trunk  and  extremi- 
ties are  not  developed  proportionally;  the  head  is  too 
large ;  the  limbs  are  badly  adapted  to  a  feeble  body, 
which  is  too  long  or  too  short ;  the  limbs,  too,  have  not 
their  proper  length ;  the  joints  are  generally  too  large. 

The  median  line,  (a  vertical  line  dividing  the  body 
longitudinally  into  two  equal  parts,  the  one  right  and 
the  other  left,)  is  frequently  not  in  the  centre  of  the 
body;  it  seems  as  if  its  two  halfs  a?e  not  properly  joined, 
39 


610 


SCROFULA. 


one  being  higher  and  more  anterior  than  the  other. 
This  latter  arrangement,  a  consequence  of  unequal 
development,  indicates  an  unfavorable  prognosis  of  those 
diseases  which  will  supervene  afterwards. 

Not  unfrequently  there  is  a  want  of  union  on  one  or 
several  points  of  the  median  line.  It  is  generally  scro- 
fulous subjects  who  present  instances  of  separation  of 
the  linea  alba,  (Chaussier  calls  the  linea  alba  the  Ugne 
mediane  of  the  abdomen.)  Hare-lips,  which  are  simple 
or  complicated,  with  a  separation  of  the  bones  of  the 
palatine  arch,  and  the  two  halves  of  the  vetwm palati,  (a 
movable  soft  and  broad  septum,  attached  to  the  poste- 
rior extremity  of  the  palatine  arch,  and  separating  the 
mouth  from  the  pharynx.)  In  some  children  the  chest 
is  misshaped ;  the  ribs  are  twisted ;  the  sternum,  (breast 
plate,)  projects  upward  and  forward,  and  its  different 
component  parts  can  be  felt  under  the  skin ;  the  antero- 
posterior diameter  of  the  chest  is  greater  than  the  trans- 
verse. 

This  defective  formation  may  change  progressively 
between  the  ages  of  eight  and  twelve  years.  When  this 
does  not  occur,  we  may  still  hope  that  at  the  period  of 
puberty  the  deformity  may  be  modified,  and  that  the 
bony  frame  of  the  chest  may  approach  the  healthy 
state ;  but  more  frequently  it  continues,  and  thus  pre- 
vents the  regular  developement  and  complete  expansion 
of  the  lungs,  which  is  an  unfavorable  sign,  for  it  indi- 
cates that  the  scrofula  is  deeply  rooted  in  the  system. 

Scrofulous  persons  are  generally  short  in  stature,  but 
sometimes,  on  the  contrary,  very  tall.  These  two 
extremes  depend  on  the  same  principle,  that  vitality  has 
not  power  sufficient  to  regulate  the  developement  of  the 
organs,  which  are  thifs  arrested  in  the  commencement, 


SCROFULA. 


Gil 


or  receive  an  unlimited  degree  of  nutrition.  The  mouth 
is  small  or  much  too  large ;  the  teeth  of  the  first  and 
second  dentition,  but  especially  the  latter  appear  late. 
They  are  not  white,  but  have  a  blackish  tint,  decay 
readily,  and  are  very  friable.  The  spongy  tissue  of  the 
bones  are  too  much  developed  in  proportion  to  their 
compact  tissue  and  the  soft  parts.  This  state  of  the 
spongy  tissue  is  easily  recognised  by  the  following 
marks,  which,  however,  do  not  always  co-exist :  The 
malar  hone  (cheek  bone,)  is  too  prominent ;  the  base  of 
the  lower  jaw  is  too  much  developed,  which  gives  the 
individual  a  peculiar  rachitic  appearance.  The  extrem- 
ities of  the  long  bones  are  too  large  :  the  feet  and  hands, 
which  are  formed  principally  of  short  and  spongy  bone?, 
present,  in  some  cases,  an  unnatural  and  ungraceful 
developement.  The  different  portions  of  the  pelvis  gen- 
erally are  in  a  state  of  enlargement,  which  is  much  to 
be  dreaded  in  females. 

The  excrementitious  functions  are  irregular.  The 
skin,  cellular  tissue,  are  extremely  thin,  or  in  a  state  of 
peculiar  hypertrophy,  indurated  hypertrophy,  (enlarge- 
ment.) 

Many  scrofulous  subjects  have  a  dry  skin,  covered 
with  a  cutaneous  eruption ;  there  is  a  general  want  of 
transpiration,  although  partial  sweating  of  the  feet, 
hands,  and  under  the  arms  often  occur.  These  sweats 
generally  have  a  marked  acid  smell. 

The  physiognomy  seems  prematurely  old  in  infancy, 
and  at  a  later  period  the  contrary  is  true ;  the  trunk 
and  the  limbs  are  then  younger  than  the  individual, 
that  is,  they  have  not  the  developement  nor  the  force 
generally  seen  in  healthy  persons  of  the  same  age. 

Children  of  a  scrofulous  constitution  often  experience 


612 


SCROFULA. 


a  spontaneous  degree  of  lassitude,  which  is  increased 
rather  than  diminished  by  repose. 

The  swelling  of  the  upper  lip  is  peculiar,  it  is  more 
marked  in  the  morning  than  during  the  day ;  in  some 
young  girls  the  swelling  is  not  manifest  except  for  a  few 
hours  after  rising. 

It  is  not  necessary  to  enlarge  any  farther  on  this  part 
of  the  subject,  but  you  would  naturally  conclude  from 
the  preceding  remarks  that  it  is  very  evident  that  when 
children  inherit  scrofula  from  their  mothers,  maternal 
nursing  can  only  develope  the  proximate  cause  of  their 
malady.  A  child,  therefore,  born  with  scrofula,  will 
necessarily  become  more  scrofulous  if  nursed  by  the 
mother. 

A  scrofulous  child  should  be  raised  if  possible  in  the 
country.  Children  of  this  habit  are  peculiarly  suscepti- 
ble of  cold,  and  should  therefore  be  well  defended  against 
vicissitudes  and  variations  of  temperature.  Many  a 
delicate  child  has  been  sacrificed  to  the  false  notion  of 
hardening  the  constitution  by  exposure,  which  is  un- 
fortunately so  prevalent  in  the  present  da}*.  Cold  spong- 
ing or  bathing  is  a  most  powerful  means  of  increasing 
the  vigor  and  diminishing  the  tendency  to  catarrhal 
attacks,  but  it  should  not  be  too  early  adopted  in  the 
case  of  scrofulous  children,  as  their  powers  of  reaction 
are  small.  The  water  should  be  tepid  in  the  first 
instance,  and  gradually  diminished  in  temperature. 

Symptoms. — The  first  symptoms  of  disease  as  manifest 
generally,  is  enlargement  of  the  glands,  and  frequently 
in  various  portions  of  the  body,  --particularly  in  the 
neck,  behind  the  ears,  and  under  the  chin,  which,  after 
a  time,  suppurate  and  degenerate  into  ulcers,  from  which, 


SCROFULA. 


613 


instead  of  pus,  a  white  curdled  matter  somewhat  resemb- 
ling the  coagulum  of  milk  is  generally  discharged." 

It  is  the  superficial  glands  that  are  most  frequently 
affected,  they  take  on  a  gradual  enlargement,  and  soon 
become  a  very  hard  tumor.  Whether  it  originates  in 
the  external  or  internal  glands  it  is  apt  to  extend  from 
one  gland  to  another,  especially  those  that  have  their 
locality  along  the  seat  of  the  absorbents,  in  which  it 
first  originated. 

Where  the  predisposition  to  the  disease  is  very  strong, 
in  such  cases  it  by  no  means  confines  itself  entirely  to 
the  glands,  swellings  originate  in  the  subcutaneous 
cellular  tissue,  not  confining  itself  to  any  particular 
locality,  pus  is  secreted,  numerous  abscesses  are  formed, 
through  which  the  pus  is  eliminated. 

The  duration  of  scrofula  varies  in  many  instances, 
more  especially  when  the  external  glands  are  involved; 
under  proper  treatment  it  will  sometimes  yield  in  a  few 
weeks,  whilst  again  it  will  resist  treatment  for  months 
or  years,  this,  however,  is  to  be  attributed  in  many 
instances  to  the  peculiar  idiosyncrasy  of  the  patient. 
The  ulcers  most  generally  heal  very  slowly,  and  when 
healed  leave  a  scar  of  an  indurated  and  callous  char- 
acter. 

Diagnosis. — Scrofulous  inflammation  of  the  glands  is 
distinguished  from  ordinary  chronic  inflammation  of  the 
same  parts  by  the  greater  hardness  of  the  tumors,  their 
less  degree  of  tenderness  upon  pressure,  their  longer 
continuance,  and  greater  indisposition  to  yield  to  treat- 
ment, their  frequent  complication  with  other  scrofulous 
affections,  and  by  the  state  of  system  which  precedes  or 
attends  them.  The  practitioner  will  also  be  influenced 
in  forming  his  judgment  by  the  hereditary  or  family 


614 


SCROFULA. 


influences  which  may  have  seemed  to  create  a  peculiar 
predisposition  in  the  patient.  When,  upon  the  occur- 
rence of  suppuration,  the  curdy  matter  above  referred 
to  is  discharged,  there  can  be  no  doubt  as  to  the  scrofu- 
lous nature  of  the  case. 

Treatment. — From  its  nature  and  peculiar  causes  it  is 
very  perceptible  that  the  treatment  should  be  both 
hygienical  and  therapeutical,;  "and  that  the  former  is, 
perhaps,  of  even  more  importance  than  the  latter." 
Sometimes  the  tumors  will  resist  all  of  your  applications, 
and  even  if  they  should  yield  to  your  remedies  appa- 
rently, they  will  frequently  again  develope  themselves  in 
a  more  dangerous  locality;  and  an  author  who  has  had 
much  experience  in  this  class  of  diseases,  asserts,  that 
it  is  no  uncommon  event  for  the  recession  of  scrofulous 
swellings  upon  the  neck,  or  from  other  external  situa- 
tions, to  be  followed  by  pulmonary  consumption.  And 
the  late  Dr.  Parrish,  of  Philadelphia,  whose  experience 
was  ample,  had  so  much  dread  of  such  translations, 
that  he  always  employed  measures  calculated  immedi- 
ately to  discuss  scrofulous  tumors  with  great  caution, 
and  generally  preferred  leaving  them  entirely  alone, 
addressing  his  remedies  solely  to  the  system. 

Of  all  the  remedies  that  have  been  most  extensively 
used,  iodine  is,  by  many  regarded  as  decidedly  the  most 
beneficial.  M.  Sugol  considers  it  the  most  effica- 
cious remedy  we  possess  in  scrofula ;  he  recommends 
especially,  the  watery  solution,  which  bears  his  name, 
internally,  and  baths  of  iodine  externally;  it  is  a 
valuable  remedy,  especially  when  alternated  with  cod 
liver  oil,  neither  of  which  preparations  do  I  deem  it 
prudent  to  administer,  if  there  should  be  any  inflamma- 
tory excitement.    Sugol's  solution  is  as  follows  : 


SCROFULA. 


615 


It.    Iodine,  2)L 
Potassii  iodidi,  3ii. 
Distilled  water,  f.5vii. 

Dissolve.  Dose — ten  drops,  gradually  increased,  three 
times  a  day. 

Cod  liver  oil  is  regarded  by  many,  and  especially  by 
the  author,  as  a  valuable  agent  in  this  disease.  The 
dose  for  an  adult,  is  from  one  to  two  table-spoonsful  two 
or  three  times  a  day  in  coffee. 

One  of  the  most  useful  remedies,  is  the  pipsisseica, 
which  may  be  given  with  impunity  for  a  long  time. 
The  decoction  should  be  given  to  the  amount  of  half  a 
pint  daily,  to  an  adult,  and  in  proportion  to  a  child. 
In  any  stage  of  the  disease,  I  have  confidence  in  the 
stiU'uvjia  sylmtica,  (Queen's  delight,  or  yaw  root,)  it  can 
be  used  ad  libitum,  in  infusion,  decoction  or  syrup.  I 
would  advise  taking  a  considerable  quantit}T,  about 
three  times  a  day. 

To  discuss  the  tumors  and  enlarged  glands,  especially 
before  active  inflammation  is  manifested  or  developed, 
apply  slippery  elm  poultices,  well  saturated  with  the 
compound  tincture  of  myrrh.  Some  advise  the  dis- 
cutient  ointment. 

In  threatening  or  incipient  inflammation,  make  a 
poultice  of  the  indian  turnip,  and  apply,  changing  it 
three  times  a  day. 

If  you  cannot  discuss  the  glands,  you  should  change 
tactics,  and  invite  suppuration  as  speedily  as  possible, 
for  this  purpose,  apply  emolient  fomentations,  poultices 
of  flaxseed,  &c.  After  the  abscess  is  formed,  it  should 
be  thoroughly  cleansed  daily,  with  a  weak  solution  of 
vegetable  caustic.    Dr.  Beach  says  that  he  has  found  by 


616 


SCROFULA. 


experience,  the  hayberry  to  be  one  of  the  most  extraor- 
dinary remedies  in  scrofula,  particularly  in  a  state  of 
ulcer,  it  is  superior  to  any  other  article  either  in  the  ani- 
mal, vegetable  or  mineral  kingdoms  ;  and  if  there  is  a 
specific  in  this  complaint,  he  regards  this  plant  as  one ;  if 
there  is  a  sinus  in  addition  to  the  ulcer,  it  must  be  injected 
thoroughly,  morning  and  night,  with  a  strong  concen- 
trated decoction  of  bayberry  bark  alternately,  with  a 
solution  of  the  vegetable  caustic  \  a  tea-spoonful  to  a 
half  a  pint  of  water. 

The  goodyera  pubescens,  (scrofula  weed,)  is  much 
lauded  for  the  cure  of  this  disease.  Some  advise  the 
fresh  leaves  to  be  steeped  in  milk,  and  applied  to  scro- 
fulous ulcers  in  poultice,  or  the  fresh  leaves  bruised, 
may  be  laid  on,  and  renewed  every  three  hours ;  at  the 
same  time,  the  warm  infusion  must  be  drank  freely. 

A  strong  decoction  of  the  common  agrimony,  sweetened 
with  honey,  is  reputed  to  cure  scrofula  almost  invari- 
ably, if  its  use  is  persisted  in. 

In  Germany,  coffee  made  from  roasted  acorns,  is  a 
favorite  remedy.  Of  late,  the  European  treatment  in 
the  hands  of  Professor  Negrier,  has  been  found  in  the 
highest  degree  efficacious ;  he  gives  to  children,  a  tea- 
cup full  of  the  strong  infusion  of  the  leaves,  or  six 
grains  of  the  aqueous  extract ;  if  there  were  ulcers  or 
sore  eyes,  a  strong  decoction  was  applied  to  them. 

The  fresh  root  of  the  yellow  dock,  bruized  in  lard  or 
butter,  forms  an  excellent  ointment  for  scrofulous 
ulcers,  they  are  a  discutient  for  the  glandular  tumors, 
and  a  fine  application  for  scrofulous  opthalmia. 

The  burnt  sponge  is  used  in  combination  with  iodine 
and  morphia,  and  I  have  no  doubt  but  that  it  is  a  valu- 


SCROFULA. 


617 


able  compound.  The  following  recipe  has  acquired 
much  reputation : 

^.    Take  of  iodine,  grs.  50. 

Sulphate  of  morphine,  grs.  x. 

Burnt  sponge,  grs.  100. 

Triturate  well  together ;  form  into  one  hundred  pills 
by  the  addition  of  syrup.  Keep  them  in  a  dry  place. 
Give  two  or  three  pills  daily. 

I  have  no  hesitation  in  recommending  the  following 
scrofulous  syrup,  viz : 

Take  of  yellow  dock  root,  two  pounds ;  bark  of  the 
root  of  false  bitter-sweet,  one  pound;  root  of  fifeleaf, 
(ampelopsis  quinq.)  and  root  and  herb  of  figwort,  (scroft. 
mariland.)  each,  half  a  pound. 

Grind,  and  mix  the  articles  together,  place  the  whole 
four  pounds  in  a  convenient  vessel,  cover  them  with 
alcohol  of  seventy-six  per  cent.,  and  macerate  for  two 
days.  Then  transfer  the  whole  to  a  common  displace- 
ment apparatus  or  percolator,  and  gradually  add  hot 
water,  until  two  pints  have  been  obtained,  which  retain 
and  set  aside. 

2.  Then  continue  the  percolation,  and  of  the  second 
solution  reserve  so  much  as  contains  a  sensible  amount 
of  spirit,  and  distill  or  evaporate  the  alcohol  from  it. 

3.  Continue  the  displacement,  by  hot  water,  until  the 
solution  obtained  is  almost  tateless,  and  boil  down  this 
weaker  infusion  till  it  begins  to  thicken,  or  until,  when 
added  to  the  balance  remaining  of  the  second  portion, 
after  the  evaporation  of  the  alcohol,  it  will  make  twelve 
pints. 

4.  To  these  two  solutions  combined,  add  sixteen 
pounds  of  refined  sugar,  and,  by  heat,  dissolve ;  care- 


CIS 


SCROFULA. 


fully  removing  the  scum  which  arises  as  it  comes  to  the 
point  of  boiling.  Then,  if  it  exceeds  that  quantity, 
evaporate  the  syrup  with  constant  stirring,  to  fourteen 
pints ;  remove  from  the  fire,  and  when  nearly  cold,  add 
the  two  pints  of  tincture  first  obtained,  and  make  two 
gallons  of  sjTup.  To  every  pint  of  syrup  add  one  ounce 
of  the  hydrodate  of  potass.  Dose,  table-spoonful  three 
or  four  times  a  day. 

It  cannot  be  doubted  that  many  of  these  alteratives 
are  highly  efficient  in  the  cure  of  this  disease ;  doubtless 
some  have  a  reputation  beyond  their  merits;  it  is  a 
blessing  that  we  have  such  a  variety,  especially  for  the 
accommodation  of  those  patients  whose  tastes  are  so 
diversified. 

The  chlorides  of  barium,  calcium,  sarsaparilla,  guaia- 
cum,  and  mezeron,  have  all  enjoyed  much  reputation  in 
this  disease ;  but  amongst  all  of  these,  I  believe  the  mass 
of  authority  is  ,in  favor  of  iodine  and  cod  liver  oil. 
Some  are  decidedly  against  the  remedy  in  every  shape. 
"  The  efficacy  of  this  medicine  has  been  too  variously  and 
abundantly  tested  to  admit  of  reasonable  question.  It 
may  be  employed  in  all  forms  and  stages  of  the  com- 
plaint, unless,  perhaps,  where  it  is  attended  with  febrile 
excitement." 

When  the  ulcers  are  not  disposed  to  heal,  the  black 
salve  may  be  applied,  or  weak  nitric  acid,  and  other 
similar  preparations. 

Regimen. — Reference  must  be  had  to  the  stage  of  the 
disease,  and  the  peculiar  state  of  the  system ;  if  there  is 
inflammation  or  febrile  excitement,  the  patient  should 
then  be  confined  to  a  light  vegetable  diet ;  on  the  con- 
trary, if  he  is  debilitated  he  should  have  animal  food. 


"WHITE  SWELLING. 


G19 


The  diet  should  be  nutritious,  principally  milk.  Salt 
water  baths  should  be  freely  indulged  in. 

HYDRARTHRUS. 

White  Swelling. — This  very  formidable,  inveterate 
and  painful  disease  is  confined  to  some  one  of  the  joints, 
most  frequently  the  knee,,  but  I  have  seen  it  in  the  hip 
and  elbow.  There  is  evidently  two  varieties  of  this 
very  painful  disease,  and  the  distinction  should  be  made 
very  clear.  We  have  what  is  termed  rheumatic  white 
swelling,  and  again,  scrofulous  or  true  white  swelling, 
which  is  confined  entirely  to  those  of  a  scrofulous  dia- 
thesis. 

Rheumatic  White  Swelling. — In  this  variety  the  liga- 
ments around  the  diseased  joint  take  on  an  abnormal, 
(unhealthy,)  act'on,  they  become  very  much  distended; 
and  frequently  there  is  a  very  great  dropsical  effusion ; 
it  is  not  attended  with  much  pain ;  the  limb  frequently 
becomes  very  much  contracted,  and  the  least  exercise 
produces  great  aggravation  of  all  the  symptoms. 

Treatment. — In  this  variety  of  white  swelling  my 
experience  is  limited,  but  I  should  advise  the  same  con- 
stitutional treatment  to  be  resorted  to  as  recommended 
and  advised  for  rheumatism.  It  will  require  a  more 
active  treatment  of  purgation. 

In  regard  to  the  local  treatment,  which  should  first 
claim  consideration,  the  parts  should  be  cupped  freely, 
and  the  following  stimulating  liniment  applied.  It  is 
termed  in  the  dispensatories  "  Rheumatic  Tincture," 
"  Rheumatic  Drops  or  Liniment."    It  is  as  follows,  viz. : 

Take  camphor,  one  pound;  oil  of  origanum,  oil  of 
hemlock,  of  each  half  a  pound ;  oil  of  sassafras,  oil  of 
cajeput,  of  each  two  ounces;  oil  of  turpentine,  one 


620 


WHITE  SWELLING. 


ounce ;  cayenne,  four  ounces ;  alcohol,  one  gallon.  Ma- 
cerate for  two  weeks,  and  filter. 

This  is  a  most  excellent  local  application  in  painful 
affections  of  this  or  any  other  character. 

In  ordinary  cases,  apply  two  to  four  tea-spoonsful  to 
the  affected  part  several  times  a  day,  and  after  bathing 
as  above  directed,  apply  an  additional  piece  of  flannel, 
which  must  be  kept  constantly  wet  with  the  drops  until 
relieved.  This  should  be  followed  by  the  bandage, 
rolled  on  with  a  considerable  amount  of  compression, 
beginning  at  the  toes  and  letting  your  baaidage  extend 
above  the  affected  part. 

So  soon  as  the  first  symptom  of  the  disease  presents 
itself,  which  you  can  readily  distinguish  from  the  very 
severe  pain  felt  deep  in  the  joint,  and  from  the  fact  that 
there  is  considerable  swelling,  attended  with  very  little 
redness  of  the  surface,  you  should  then  subject  the 
affected  part  to  the  influence  of  bitter  herb  fomentations 
at  least  twice  a  day,  such  as  the  following :  Marsh  mal- 
lows, tansy,  hops  or  wormwood;  make  a  strong  decoc- 
tion, and  add  half  a  pint  of  soft-soap ;  boil  again  a  few 
minutes,  and  place  the  limb  over  the  steam,  with  a 
blanket  around  to  prevent  any  escape  of  it ;  and  con- 
tinue this  application  for  fifteen  minutes ;  the  linament 
to  be  applied  after  each  fomentation,  and  the  bandage 
worn  in  the  intervals.  As  a  general  rule  the  fomenta- 
tion should  be  repeated  once  a  day. 

If  the  swelling  remain  obstinate  after  the  cupping 
and  compression  have  been  tried  for  some  time,  get  and 
keep  up  a  free  suppuration  for  several  weeks,  from  the 
whole  affected  surface,  by  means  of  the  irritating  plas- 
ter. 

I  have  introduced  setons  in  some  very  obstinate  cases, 


WHITE  SWELLING. 


621 


and  have  seen  much  benefit  accrue  from  their  introduc- 
tion. 

Dr.  Beach  recommends,  after  fomentation,  the  appli- 
cation of  a  poultice,  and  I  have  no  doubt  it  would  be 
attended  with  benefit.  He  uses  the  following:  One 
handful  of  dandelion  roots,  one  handful  of  the  hearts  of 
mullien,  and  the  same  quantity  of  catnip ;  boil  them  in 
sweet  milk,  and  thicken  with  wheat  flour ;  steam  in  the 
evening  and  poultice  every  morning  until  the  swelling 
breaks ;  after  which  it  should  be  washed  with  a  weak 
solution  of  mild  caustic  until  the  discharge  presents  a 
healthy  appearance.  You  should  then  use  Beach's  Salve 
to  heal  the  wound.  It  is  made  as  follows :  Take  one 
handful  of  English  clover,  a  lump  of  rosin  as  large  as  a 
walnut,  half  a  pound  of  sheep's  tallow,  and  one  handful 
of  bitter  sweet  berries ;  stew  them  on  embers ;  apply  the 
salve  twice  a  day.  Take  an  equal  quantity  of  red  pre- 
cipitate and  loaf  sugar,  with  a  small  lump  of  charcoal, 
and  powder  them,  to  cleanse  the  sore  of  proud  flesh.  If 
the  sinews  should  be  contracted,  take  a  pint  bottle,  pour 
it  half  full  of  sweet  oil,  then  fill  it  up  with  chamomile 
flowers ;  let  it  hang  in  the  sun  three  days,  taking  it  in 
every  evening.  Hub  the  sinews  hard  with  this  twice 
every  day,  and  heat  it  in  with  a  hot  iron. 

If,  after  having  removed  the  soreness,  the  joint  admit 
of  any  motion,  hopes  may  be  entertained  from  further 
treatment ;  but  if,  on  the  contrary,  it  be  stiff  and  im- 
movable, any  attempt  to  disturb  it  by  motion  will  do 
harm.    It  should  be  let  alone. 

If  the  joint  admit  of  motion,  machinery  which  will 
gradually  extend  the  limb,  such  as  Dr.  Chase's  appara- 
tus, (of  Philadelphia,)  will  answer  for  this  purpose. 
"While  the  machinery,  whatever  it  be,  is  applied  to  make 


622 


WHITE  SWELLING. 


the  extension  absolute,  rest  on  the  part  of  the  patient 
should  be  enjoined.  He  must  not  be  allowed  to  attempt 
any  use  of  the  limb,  or  any  other  exercise.  He  should 
be  kept  perfectly  free  from  all  mental  excitement  or 
anxiety,  and  as  much  retired  from  company  as  possible. 
As  soon  as  the  limb  has  become  straight,  or  as  straight 
as  is  thought  practicable,  all  further  use  of  the  extend- 
ing force  must  be  discontinued ;  but  the  limb  should  be 
kept  in  that  position  until  free  from  all  tenderness,  if 
any  should  have  been  induced  by  the  treatment. 

The  rattle-snake,  as  well  as  snapping-fcurtle  oil,  are 
both  highly  recommended  in  contracted  limbs — the  for- 
mer must  not  be  continued  too  long,  as  it  is  apt  to 
induce  weakness  of  the  affected  limb. 

Scrofulous,  or  True  White  Swelling. — Upon  this  sub- 
ject, as  our  experience  has  been  limited,  I  cannot  do 
better  than  to  quote  from  an  eclectic  author,  his  peculiar 
views  and  treatment  of  this  disease ;  this  variety  never 
occurs  in  any  but  scrofulous  persons.  It  is  nothing 
more  nor  less  than  scrofula  in  a  joint.  He  says,  that 
for  a  long  time  after  the  disease  has  located  itself  in  the 
joint,  1the  pain  may  be  very  slight.  Gradually  the  pa- 
tient's sufferings  increase,  and  become  at  last  very  in- 
tense, particularly  at  night.  The  central  part  of  the 
joint  seems  the  point  most  affected.  The  swelling,  also, 
is  very  slow  in  its  progress,  except  in  cases  of  a  very 
marked  scrofulous  character.  Even  then,  there  is  no 
discoloration  of  the  skin,  or,  rather  it  appears  whiter 
than  natural,  (whence  the  popular  name.)  It  becomes 
very  tense,  with  a  smooth,  shining  aspect,  and  marked 
with  various  veins.  The  patient  constantly  experiences 
a  sensation  of  increased  heat  in  the  part.  In  this  con- 
dition the  joint  may  remain  for  months,  or  even  years, 


WHITE  SWELLING. 


623 


without  any  material  change.  Gradually,  however,  the 
tumefaction  increases,  till  the  thickening  of  the  soft 
parts  becomes  so  hard  as  to  present  the  appearance  of 
enlarged  bone;  in  very  bad  cases,  involving  the  car- 
tilages of  the  knee,  (for  as  that  is  the  joint  most 
commonly  affected,  we  may  as  well  study  the  disease  as 
there  manifested,)  the  tibia,  or  large  bone  between  the 
knee  and  ancle,  is  thrown  backward,  the  condyles  of  the 
femur  or  thigh  bone  projecting  forward.  The  limb, 
both  above  and  below  the  knee,  emaciates ;  and  as  a 
flexed  position  is  easiest  for  the  sufferer,  anchylosis 
(stiff  joint)  takes  place,  with  the  limb  permanently 
bent.  Finally,  matter  collects  in  the  joint,  either  from 
ulceration,  of  the  cartilage  or  bone,  or  both,  and  sinuses 
form  for  its  discharge.  Extensive  caries  (decay)  may 
ensue,  producing  severe  constitutional  irritation,  under 
which  the  patient  gradually  sinks. 

Medical  treatment  is  not  generally  resorted  to, — at 
least,  a  physician  is  not  called,  until  organic  injury  to 
the  limb  has  occurred, — until,  at  least,  there  is  conside- 
rable enlargement  of  the  joint,  with  constitutional  de- 
bility. As  it  is  then  too  late  to  prevent,  yotfr  best 
means  is  to  remove  the  inflammation  and  swelling,  by 
cupping  and  scarifying  the  whole  surface,  except  any 
part  that  may  be  actually  ulcerated.  After  this,  apply 
the  irritating  plaster,  and  on  removing  the  plaster,  cup 
and  scarify  again,  until  free  suppuration  is  excited. 
When  this  is  brought  about,  continue  to  dress  it  twice  a 
day  with  the  plaster,  to  keep  up  the  discharge.  After  each 
dressing,  subject  the  limb  to  the  bitter  herb  fomenta- 
tions, by  placing  it  over  a  vessel  containing  hops  and 
tansy,  to  which  may  be  added,  with  good  effect,  the 
ambrosia  elatoir,  (Roman  wormwood.)    It  is  better  also 


G24 


WHITE  SWELLING. 


to  add  vinegar  to  the  water ;  the  vapor  being  confined 
by  a  blanket.  If  the  application  of  the  irritating  plas- 
ter prove  too  painful,  an  emollient  poultice  may  be  occa- 
sionally used  instead,  (and  for  this  purpose,  from  my 
own  experience,  you  will  find  the  pearl  flowered  life- 
everlasting  a  most  capital  emollient.)  After  continuing 
this  course  for  ten  or  twelve  days,  or  until  pain  and 
swelling  have  nearly  subsided,  you  may  allow  the  sore 
produced  by  the  plaster  to  heal.  Then  follow  up  with 
your  stimulating  applications,  (as  advised  for  rheumatic 
white  swelling,)  and  compression  with  the  bandage,  as 
strong  as  the  patient  can  bear. 

If  there  be  ulceration,  with  one  or  more  sinuses  open- 
ing on  the  surface,  inject  a  solution  of  mild  caustic. 
Wash  them  out  freely  with  this  once  or  twice  a  day. 
This  lotion  is  to  be  strengthened  as  the  patient  can  bear 
it  or  until  the  discharge  becomes  healthy.  After  that, 
wash  it  out  simply  with  soap  and  water,  and  allow  it 
to  heal. 

Continue  the  steaming  operation  at  least  once  a  da}-, 
with  stimulants  and  compression  in  the  interim. 

After  having  cleansed  the  parts  with  the  vegetable 
potash,  if  the  bone  be  not  affected,  discontinue  that  arti- 
cle, and  use  the  more  active  stimulants  proper,  such  as 
the  compound  tincture  of  myrrh.  The  caustic,  however, 
is  to  be  resumed,  if  there  is  no  tendency  to  healing,  or 
the  discharge  at  any  time  takes  on  an  unhealthy  appear- 
ance; the  latter  symptom  will  give  reason  to  suspect 
the  hone  to  be  involved.  This  can  be  ascertained  by 
the  probe,  or  by  close  inspection  of  the  discharge.  As 
long  as  soft,  decayed  bone,  or  discharged  pieces  can  be 
discovered,  the  caustic  must  be  persevered  with.  When 
these,  with  all  fungous  growths,  have  disappeared,  dis- 


WHITE  SWELLING. 


625 


continue  the  caustic  and  resume  the  stimulants.  The 
cupping  and  scarifying  may  be  likewise  repeated  should 
occasion  arise. 

Some  cases  will  prove  very  tedious,  and  occasionally 
assume  under  treatment  a  very  irritable  character.  All 
the  measures  recommended  must  then  be  laid  aside, 
except  the  fomentations  and  emollient  poultices,  until 
the  irritation  is  allayed. 

In  any  case  of  true  scrofulous  white-swelling  a  perma- 
nent cure  need  not  be  looked  for,  however  judicious  the 
local  treatment,  without  the  proper  constitutional  reme- 
dies. The  patient's  surface  should  be  subjected  daily 
to  efficient  bathing  and  frictions  and  his  bowels  kept  in 
a  soluble  condition.  I  would  recommend  those  reme- 
dies to  be  used  that  I  have  advised  in  scrofula. 

Any  form  of  this  disease  will  be  tedious  and  trouble- 
some. "  It  is  important  that  you  forewarn  the  patient 
and  his  friends  of  the  necessity  of  persevering  in  the 
treatment  a  sufficient  length  of  time.  In  some  cases  a 
cure  cannot  be  anticipated  in  less  than  half  a  year," 
though  in  some,  half  that  time  may  be  sufficient. 

The  following  remedies  are  much  estimated  by  many 
authors  :  Cod  liver  oil,  both  internally  and  more  espe- 
cially externally. 

I^j.    Lunar  caustic,  four  parts. 
Lard,  thirty  parts. 
You  can  increase  the  salt  up  to  eight.    Valuable  as 
a  local  application. 

A  cataplasm  that  I  have  used  beneficially,  is  the 
following : 

II.    Chloride  of  sodium. 

  soda,  aa.  Bss. 

40 


626 


RICKETS. 


Water,  half  a  pint. 
Linseed  meal,  sufficient. 

This  is  a  most  excellent  cataplasm  in  either  variety  of 
white-swelling. 

EACHITIS. 

Rickets. — This  is  a  very  peculiar  disease,  and  a  variety 
of  opinions  have  been  promulgated  in  regard  to  its 
pathology ;  it  has  been  by  some,  allied  to  syphilis  and 
scurvy;  my  own  impression  is,  that  it  arises  from  a 
deficiency  of  the  earthy  substance,  in  the  formation  and 
growth  of  the  bones,  and  I  am  satisfied  that  if  it  has 
any  affinity,  in  a  pathological  point  of  view,  to  any  class 
of  diseases,  that  it  approximates  more  closely  to  scro- 
fula than  anything  else,  and  I  have  consequently  in- 
cluded it  under  the  head  of  that  class  of  diseases. 

Symptoms. — One  of  the  earliest  symptoms  of  the 
disease,  manifests  itself  in  the  glands,  and  there  is  a 
peculiar  softness  of  the  flesh  ;  the  bowels,  or  rather  the 
abdomen,  becomes  enlarged,  whilst  at  the  same  time 
there  is  a  gradual  emaciation  going  on,  the  face  not 
only  swells,  but  becomes  very  sallow.  If  the  disease 
makes  its  appearance  during  dentition,  the  process  is 
not  only  slow,  but  very  imperfect;  when  the  teeth  appear, 
they  are  evidently  unsound,  liable  to  drop  from  the 
socket,  and  are  carious.  The  peculiar  modification  of 
the  bony  tissue  is  one  of  ,  the  peculiar  characteristics  of 
this  disease.  The  compact  surface  of  the  bones  is  thin. 
In  the  cellular  structure,  composing  the  greater  portion, 
the  cells  are  preternaturally  large,  and  filled  with  a  glu- 
tinous substance ;  the  extremities  of  the  long  bones 
become  spongy,  and  the  joints,  consequently,  appear 
swollen ;  in  some  instances,  mere  cartilage  occupies  the 


RICKETS. 


G27 


place  of  bones,  consequently,  in  this  state,  the  limbs 
are  unable  to  support  the  body,  and  therefore  pressure 
upon  them  produces  great  deformity ;  and  for  this 
reason,  as  well  as  owing  to  the  action  of  the  muscles 
inserted  into  them,  they  become  crooked  and  very  much 
distorted. 

The  head  becomes  greatly  enlarged  and  deformed,  the 
fontanelle  and  sutures  (belonging  to  the  head)  are  de- 
cidedly more  open,  and  on  this  account,  as  I  before 
observed,  the  head  appears  large  in  proportion  to  the 
rest  of  the  body.  The  sternum  (or  breast  bone)  is  very 
projecting,  and  if  a  close  examination  be  instituted,  it 
will  in  almost  every  case  be  found  that  this,  owing  in  a 
great  measure  to  a  forward  deviation  of  the  vertebral 
column,  this  action  has  a  tendency  to  produce  various 
curvatures  of  the  spine,  while  at  the  same  time  the 
whole  pelvis  is  compressed  by  the  weight  of  the  body  to 
such  an  extent  as  to  cause  the  two  acetabula  (cavities  that 
receive  the  head  of  the  thigh  bones,)  toward  each  other, 
and  throws  the  prominent  portion  of  the  sacrum  forward, 
contracting  the  pelvis  in  many  instances  to  very  narrow 
dimensions. 

An  author  of  much  experience,  asserts  that  the  urine 
in  rickets  has  been  observed  to  vary  much  in  its  com- 
position, from  the  normal  type,  the  deviations  consisting 
chiefly  in  the  diminution  of  urea  and  of  uric  acid,  and 
in  the  increase  of  the  salts.  The  color  of  the  urine  is 
generally  either  pale,  or  differs  but  little  from  the 
healthy  appearance.  The  free  acid  sometimes,  however, 
increases  to  an  extraordinary  degree.  The  phosphates 
exceed  the  healthy  average,  and  a  considerable  sediment 
of  oxalate  of  lime  is  by  no  means  uncommon. 

There  is  a  form  of  rickets  in  which  the  head  is 


G28 


RICKETS. 


usually  so  small  and  misshapen,  that  the  intellectual 
faculties  are  incapable  of  development,  and  the  indi- 
vidual constantly  remains  idiotic ;  but,  in  slighter  cases 
of  rickety  cachexia,  it  not  unfrequently  happens  that 
there  is  unusual  mental  manifestation,  and  that  the 
young  subjects  of  it  astonish  by  their  precocity. 

If  the  child  lives  to  the  age  of  puberty,  the  bones, 
notwithstanding  these  deformities,  will  become  very 
firm  and  strong ;  large  ridges  grow  along  their  concave 
surfaces,  to  strengthen  them. 

Causes. — Doctor  Gregory  and  Sir  Astley  Cooper,  con- 
tend that  children  may  unquestionably  be  born  with  a 
predisposition  to  rickets ;  they  rarely  exhibit  any  evi- 
dences of  it  until  towards  the  termination  of  the  first 
year.  At  first,  the  progress  of  the  disease  is  very  slow, 
and  almost  imperceptible.  Although,  however,  there 
may  be  no  outward  appearance  of  scrofula  in  the  foetus 
in  utero,  there  must  be  imperfect  formation ;  and  if  we 
regard  scrofula  to  consist  in  an  arrest  or  insufficienc}^  of 
development,  the  view  would  seem  to  apply  a  fortiori 
to  rickets.  Doctor  Gregory,  however,  doubts  whether 
the  constitutions  of  parents  have  anything  to  do  with 
the  production  of  the  disease,  as  inattention  and  neglect 
are,  he  conceives,  quite  sufficient  to  account  for  the 
phenomena. 

It  is  fair  to  presume  that  parents  who  have  singly  or 
together,  labored  under  some  cachectic  vice,  (a  bad  habit 
of  body,  chiefly  the  result  of  scorbutic,  cancerous,  or 
venereal  diseases  when  in  their  last  stages,)  may  impress 
their  offspring  with  defective  plastic  energy  ;  and,  there- 
fore, that  diseases  like  the  one  now  under  consideration, 
may  have  their  foundation  in  this  manner.  But 
although  a  predisposition  may  be  thus  laid  in  organiza- 


RICKETS. 


G20 


tion,  such  predisposition,  as  in  similar  cases,  requires  to 
be  excited  into  action  before  the  mischief  can  manifest 
itself.  The  most  common  occasional  causes  would  seem 
to  be  faulty  nursing,  and  all  those  exciting  influences 
which  have  been  pointed  out,  as  productive  of  scrofu- 
lous diseases.  The  affection  is  noticed  chiefly  where 
children  cannot  obtain  sufficient  or  appropriate  nourish- 
ment, and  where  they  are  restricted  from  solar  light 
and  air,  in  ill-ventilated  and  often  damp  apartments. 
Hence,  it  prevails  chiefly  in  the  lower  ranks  of  life ; 
and,  amongst  the  children  of  those  better  off  in  the 
world,  it  is  seen  in  such  as  are  compelled  to  leave  the 
breast,  and  are  fed  frequently  on  diet  unsuitable  to  their 
aire  and  condition.     The   milk  of  nurses   who  are 

o 

addicted  to  the  use  of  spirituous  liquors,  would  appear 
to  have  often  induced  it,  especially  where  a  predisposi- 
tion derived  from  progenitors  existed. 

In  many  of  the  large  manufacturing  establishments 
of  Great  Britain,  the  children  are  proverbially  mis- 
shapen and  unhealthy.  When  the  subject  of  the  health 
of  children  in  such  estabhshments  was  brought  before 
the  British  Parliament  some  years  ago,  by  Sir  Robert 
Peel,  Mr.  Owen,  of  New  Lanark,  stated  that  although 
those  employed  in  his  manufactory  were  extremely  well 
fed,  clothed  and  lodged,  looked  fresh,  and  to  a  super- 
ficial observer,  were  healthy,  yet  their  limbs  were  gene- 
rally deformed;  their  growth  stunted,  and  they  were 
incapable  of  making  much  progress  in  the  first 
rudiments  of  education.  On  the  same  inquiry,  Sir 
A.  Cooper  stated  that  according  to  his  experience,  the 
result  of  confinement  is  not  only  to  stunt  the  growth, 
but  to  produce  deformity. 

Treatment — As  regards  the  general  management  and 


G30 


RICKETS. 


mode  of  treatment,  you  must  almost  pursue  the  same 
verbatim  as  directed  for  scrofula.  Much  depends  upon 
a  proper  regulated  diet,  and  unless  attention  is  paid  to 
this,  all  of  your  efforts  will  be  abortive ;  if  your  treat- 
ment has  been  delayed,  you  will  not  be  able  to  prevent 
deformity. 

My  own  impression  is  that  the  preparation  of  iodine, 
and  more  especially  the  compound,  known  as  the  iodide 
of  iron,  are  the  most  serviceable.  Salt  water  bathing  is 
much  extolled,  and  should  be  used  at  least  once  a  day ; 
he  should  have  the  open  air  to  breathe  constantly ;  if 
the  patient  is  at  the  breast,  the  mother  should  live  on 
animal  food.  A  decoction  of  the  cornus  florida  (dog 
wood)  should  be  applied  to  the  whole  body  after 
bathing,  and  brisk  friction  with  the  bare  hand  should 
be  used.  The  scrofulous  syrup,  which  I  recom- 
mended for  scrofula,  should  •  be  administered,  and  you 
will  derive  much  benefit  from  applying  the  following 
liniment  to  the  joints  and  spine,  viz  : 

fy.  Linseed  oil,  Hi. 
Oil  of  sassafras,  Si. 
Gum  camphor,  3i.  Mix. 

This  should  be  applied  once  or  twice  a  day ;  if  it 
produces  pain,  you  must  increase  the  oil. 

If  the  party  whom  the  child  sucks  is  troubled  with 
acidity  of  the  stomach,  she  should  take  freely,  saleratus 
or  prepared  chalk. 

I  would  advise  the  following  Tecipes,  in  many  in- 
stances they  have  proved  beneficial : 

~By.    Magnesia,  at  will. 

Phosphoric  acid,  sufficient  to  saturate. 


RICKETS. 


631 


Filter,  and  evaporate  to  dryness.  Dose. — Ten  to 
twenty  grains. 

Cod  liver  oil,  f.Si 

Solution  carbonate  potassa,  fl.oii. 

Oil  of  calamus,  gtts.  iii. 

Syrup  of  orange  peel,  fl.Si. 

Mix.  Dose,  one  to  two  fluid  drachms,  night  and 
morning. 

Or, 

^.    Cod  liver  oil, 

Syrup  of  orange  peel, 
Aniseed  water,    aa.  fl.Si 
Oil  of  calamus,  gtts.  iii. 

Mix.    Dose,  three  spoonsful  a  day. 

The  following  I  have  suggested  in  scrofula,  it  is 
highly  extolled  in  rickets,  viz : 

ty.    Acorns  roasted,  3vi. 
Coffee  roasted,  5ii. 
"Water  sufficient. 
Boil  for  a  short  time,  and  strain.    Dose,  two  or  three 
cups  full  a  day  ;  or, 

^.    Powdered  madder, 

Powdered  sugar,  aa.  3ii. 
Powdered  sulphate  of  potassa,  5ss. 

Mix  well.    Dose,  ten  grains  to  a  scruple. 


632 


INFLAMMATION  OF  THE  EAK. 


DISEASES  OF  THE  EAR. 

OTITIS. 

Inflammation  of  the  Ear. — Diseases  of  the  ear  have 
heretofore  been  almost  totally  neglected ;  of  late  years, 
however,  this  important  subject  has  engaged  the  atten- 
tion of  some  of  the  ablest  pens  in  the  profession. 

It  is  essential  to  a  correct  and  proper  treatment  that 
you  should  be  familiar  with  the  anatomical  construction 
of  the  ear. 

Most  authors  divide  the  organ  of  hearing  into  three 
parts.  First,  the  external  ear,  or  that  exterior  to  the 
membrana  tympani,  (the  membrane  lining,  what  is 
vulgarly  called  the  drum  of  the  ear.)  Second,  the 
middle  ear,  the  space  contained  between  the  membrane 
first  alluded  to  and  the  internal  ear.  And  third,  the 
internal  ear,  in  which  the  auditory  nerve  is  distributed. 
The  two  first  of  these  may  consequently  be  regarded  as 
the  physical  portion  of  the  organ  of  hearing,  the  last  as 
the  nervous  portion.  The  external  ear,  it  must  be  borne 
in  mind,  is  lined  by  a  prolongation  of  the  skin,  which 
passes  into  the  meatus  auditorius  externus,  (external 
opening  of  the  ear,)  and,  becoming  gradually  thinner  as 
it  proceeds,  is  ultimately  reflected  over  the  outer  surface 
of  the  membrana  tympani.  It  is  in  this  tegument  that 
the  sebacious  follicles  or  crypts  are  placed,  which  secrete 
the  cerumen  (or  wax  as  it  is  generally  called.)  This 
humor  sometimes  accumulates  in  the  meatus,  and  may 
be  the  source  of  deafness,  as  well  as  of  irritation  and 
inflammation  of  the  membrane.    The  distance  between 


INFLAMMATION  OF  THE  EAR. 


633 


the  external  aperture  of  the  meatus  and  the  membrana 
tympani  is  about  one  inch,  in  the  adult ;  and  by  raising 
the  pavilion  so  as  to  straighten  the  passage,  and  permit 
the  rays  of  the  sun  to  fall  into  the  meatus,  the  mem. 
brane  may  be  readily  seen.  This  can  be  much  better 
accomplished,  however,  by  means  of  an  appropriate 
speculum,  by  which,  with  the  aid  of  the  light  of  the 
sun,  or  that  reflected  from  a  mirror,  the  membrana 
tympani  and  meatus  auditorus,  (both  of  which  I  have 
explained  before,)  may  be  minutely  examined,  with  the 
view  of  detecting  any  existing  morbid  condition.  The 
external  ear  is,  consequently,  a  cul-de-sac,  formed  by  a 
prolongation  of  the  common  integument.  It  has  no 
aperture  of  communication  with  the  middle  ear.  The 
middle  ear  or  cavity  of  the  tympanum  is  bounded  ex- 
ternally by  the  membrana  tympani,  and  internally  by 
the  internal  ear.  It  communicates  with  the  cells  in  the 
mastoid  process  of  the  temporal  bone,  and  with  the 
throat  by  means  of  the  eustachian  tube.  In  the  bony 
parietes,  forming  the  boundary  between  it  and  the  inner 
ear,  there  are  two  foramina  or  (openings,)  the  foramen 
rotundum,  and  the  foramen  ovale;  both  of  which  are 
closed  by  membranes ;  and  to  the  latter  is  attached  one 
extremity  of  a  chain  of  bones  or  ossicles,  which  passes 
from  the  posterior  surface  of  the  membrana  tympani  to 
the  foramen  ovale.  In  health  the  eustachian  is  pervi- 
ous, and  readily  permits  the  passage  of  air  to  and  from 
the  middle  ear.  The  whole  of  this  cavity  is  lined  by  a 
mucous  membrane,  which  is  reflected  over  the  membrana 
tympani  proper,  passes  down  the  eustachian  tube,  and 
commingles  with  that  of  the  pharynx.  This  lining  of 
the  middle  ear  is,  in  reality,  fibro-mucous  in  its  char- 
acter, having  the  functions  both  of  a  mucous  membrane 


034 


INFLAMMATION  OF  THE  EAR. 


and  a  periosteum,  (the  membrane  covering  the  bones.) 
The  internal  ear  is  the  most  important  part  of  the  audi- 
tory apparatus,  but  it  is  of  the  least  consequence  to  the 
therapeutist,  as  it  is  beyond  the  reach  of  his  agencies. 
In  it  is  distributed  the  auditory  nerve,  which  enters 
the  meatus  auditorius  interims  in  the  petrous  portion 
of  the  temporal  bone,  passes  into  the  cavities  of  the  in- 
ternal ear,  and  terminates  in  the  different  parts  of  the 
membranous  labyrinth.  With  the  portio  mollis,  or  the 
auditory  nerve  proper,  the  portio  dura  or  facial  nerve 
proceeds  along  the  meatus  auditorius  internus,  and  passes 
through  an  opening  near  the  base  to  gain  the  aqueduct 
of  Fallopius,  along  which  it  proceeds,  receiving  the  vidian 
twig  of  the  fifth  pair,  and  giving  twigs,  containing  motor 
and  sensitive  filaments,  to  different  parts  of  the  middle 
ear. 

Inflammation  attacks  either  one,  and  sometimes  the 
whole  of  the  divisions  of  the  ear.  Where  there  is  in- 
flammation of  the  external  ear  it  "is  indicated  by 
redness,  tumefaction,  pain  and  heat  in  some  part  of  the 
external  ear,  accompanied  by  a  mucous  or  purulent 
discharge  from  the  external  ear."  The  inflammation 
may  be  confined  to  the  lining  membrane,  whence  it  has 
received  from  some  the  name  otitis  catarrhalis. 

Causes. — External  inflammation  is  frequently  con- 
nected with  a  scrofulous  habit,  and  it  is  frequently 
induced  by  the  extension  of  inflammatory  and  cutaneous 
affections  of  the  neighboring  parts,  frequently  the  result 
of  exposing  the  ear  to  a  current  of  air,  and  from  cutting 
the  hair  short,  especially  if  done  in  the  winter. 

Symptoms. — The  swelling  and  redness  can  be  per- 
ceived externally ;  where  the  inflammation  is  great  it 
is  attended  with  severe  and  acute  pain,  some  fever,  and, 


INFLAMMATION  OF  THE  EAR. 


635 


at  times,  delirium.  There  is  much  throbbing  about  the 
ear;  suppuration  generally  takes  place,  and  matter  is 
discharged. 

Treatment. — For  the  simple  earache  the  profession  is 
seldom  consulted.  Where  the  pains  and  symptoms  of 
inflammation  are  present,  fomentations  should  be  applied 
to  the  ear,  and  a  little  warm  oil  or  laudanum  dropped 
into  it.  The  following  is  a  very  good  application  to 
allay  the  pain  : — Take  hops,  a  suitable  quantity ;  vine- 
gar and  water,  equal  parts ;  simmer  till  the  strength  is 
extracted ;  enclose  the  hops  in  linen  or  flannel,  and 
apply  them  over  the  ear ;  repeat  the  same  until  the  pain 
subsides.    Let  the  feet  be  bathed  in  warm  water. 

Warm  fluids  are  sometimes  injected  into  the  ears  with 
advantage,  such  as  milk  and  water ;  but  the  introduc- 
tion of  any  substance  that  would  be  likely  to  irritate  is 
certainly  objectionable.  Where  there  is  much  pain  and 
inflammation,  a  tartar  emetic  ointment  is  recommended 
to  be  rubbed  behind  the  ear,  and  to  allay  the  inflamma- 
tion some  use  the  following  recipes  : 

1^.    Sugar  of  lead,       grs.  i.  to  viii. 
Water,  Sii. 

Or,  I^.    White  vitriol,  grs.  x. 

Water,  ii.  to  iv. 

Inject  a  small  quantity  at  a  time. 

If  this  treatment,  which  will  almost  invariably  remove 
the  pain  and  inflammation,  should  fail,  I  would  then 
advise  Beach's  direction.    He  takes  the 

Oil  of  sassafras,  Sss. 
Olive  or  sweet  oil,  5i. 
Camphor,  5i. 


636 


DEAFNESS. 


Mix.  Warm  this  liniment  and  pour  a  small  quantity 
on  a  pledget  of  cotton  and  bind  over  the  ear.  If  the 
pain  continues  drop  some  of  it  in  the  ear. 

Another  preparation  is  laudanum  and  the  juice  of 
roasted  onions,  equal  parts. 

The  bowels  should  be  freely  acted  upon,  perspiration 
promoted,  and,  if  these  fail,  give  an  anodyne. 

"  It  need  scarcely  be  said  that  attention  must,  in  all 
cases,  be  directed  to  the  cause,  and  that  this  must  be 
removed  where  practicable." 

PARACUSIS. 

Deafness. — The  recent  researches  of  Mr.  Joynbee  have 
led  him  to  infer  that  the  most  common  cause  of  deafness 
is  chronic  inflammation  of  the  lining  membrane  of  the 
middle  ear,  and  that  by  far  the  greater  majority  of  the 
cases  commonly  called  nervous  deafness,  ought  more  pro- 
perly to  be  attributed  to  this  cause. 

Deafness  is  dependent  upon  numerous  pathological 
causes  and  is  usually  applied  to  both  partial  and  total 
loss  of  hearing.  The  causes  may  affect  the  external, 
the  middle,  or  the  internal  ear. 

A  distinguished  author  says,  for  perfect  hearing,  the 
meatus  must  contain  air,  and  no  impediment,  as  hard- 
ened cerumen,  (sometimes  called  wax)  pus,  polypus,  &c, 
must  be  present  to  prevent  the  free  passage  of  the  sono- 
rous vibrations  to  the  membrana  tympani. 

Secondly. — The  causes  of  deafness  may  be  seated  in 
the  middle  ear,  and  they  may  be  of  various  kinds.  The 
membrana  tympani  may  not  be  entire;  yet  this  may 
not  destroy  the  hearing,  although  it  is  apt  to  impair  it 
more  or  less.  Persons  have  heard  distinctly  when  the 
membranes  of  both  ears  have  been  destroyed. 


DEAFNESS. 


637 


The  ossicles  (small  bones)  may  also  become  affected 
with  caries  (decay)  and  be  discharged ;  yet,  of  itself,  the 
loss  of  these  does  not  necessarily  induce  complete  deaf- 
ness, unless  the  base  of  the  stapes  (the  innermost  small 
bone  of  the  ear)  is  destroyed,  when  the  membrane  of 
the  foramen  ovale  is  apt  to  be  injured,  and  the  peri- 
lymph to  escape.  The  case  then  becomes  hopeless. 
"Whilst  the  perilymph  or  liquor  cotumnis  remains,  hear- 
ing may  exist — the  sonorous  vibrations  passing  through 
even  a  perforated  membrana  tympani,  and  being  propa- 
gated along  the  air  in  the  middle  ear  to  the  membrane 
of  the  foramen  rotunclum,  and  thence  to  the  internal 
ear. 

Thirdly. — The  causes  of  deafness  which  are  seated 
in  the  internal  ear,  are  least  understood ;  but  should  any 
thing  lead  to  the  loss  of  the  perilymph,  to  the  oblitera- 
tion or  diminution  of  the  vestibule,  cochlea  or  semi-cir- 
cular canals,  or  to  pressure  upon  the  ramifications  of  the 
auditory  nerve,  impaired  hearing  would  be  the  necessary 
consequence. 

Fourthly. — The  proper  auditory  nerve — portio  mollis 
of  the  seventh  pair — may  be  compressed  in  some  parts 
of  its  course  within  the  cranium,  or  in  the  meatus  aucli- 
torius  internus,  and  many  cases  of  deafness,  originating 
in  this  manner,  are  on  record. 

Fifthly. — Deafness  may  undoubtedly  be  owing  to  a 
morbid  condition  of  the  part  of  the  encephalon  (this 
name  has  generally  been  given  to  the  brain)  concerned 
in  the  appreciation  of  sounds. 

When  deafness  is  noted,  or  making  rapid  progress,  it 
is  essential  to  inquire  into  its  probable  causes.  It  is  a 
matter  of  great  moment,  however,  to  be  able  to  deter- 


638 


DEAFNESS. 


mine  whether  the  nerve,  or  the  portion  of  the  encepha- 
lon  connecting  with  it  is  diseased.  If,  when  a  watch  is 
placed  in  contact  with  the  teeth  of  a  deaf  person,  its 
ticking  is  not  audible,  or  imperfectly  so,  the  defect  is 
evidently  in  the  nerve — it  is  a  case  of  nervous  deafness. 

Every  case  of  deafness,  unless  caused  by  some  ex- 
traneous body  or  transient  phlegmasia,  is  apt  to  become 
worse,  •  although  it  may  remain  stationary  for  a  long 
period — at  times,  for  a  series  of  years; — the  hearing 
being  subject  to  transient  changes  of  better  and  worse, 
without  any  perceptible  cause,  and  deluding  the  patient 
with  hopes  of  ultimate  amelioration. 

Treatment. — Where  the  external  ear  is  very  much 
inflamed,  the  effect  it  produces  on  the  hearing  will  be 
transitory,  and  will  pass  away  as  the  inflammation  sub- 
sides. If  there  is  hardened  secretion  in  the  ear,  simply 
syringing  the  ear  with  warm  water,  or  warm  soap  and 
water,  will  remove  it. 

If  there  is  a  chronic  discharge  from  the  ear,  emollient 
injections  should  be  introduced  into  the  ear,  two  or 
three  times  a  day,  and  counterirritation  be  established 
behind  the  ear,  with  attention  to  the  general  health,  espe- 
cially if  the  patient  be  of  a  scrofulous  habit. 

If  there  is  inflammation  of  the  membrane  lining  the 
eustachian  tube,  you  should  apply  your  remedies  direct, 
if  possible ;  the  application  of  water,  in  connection  with 
topical  remedies,  and  an  antiphlogistic  course,  will  soon 
subdue  the  inflammation. 

In  nervous  deafness,  electricity  is  very  much  esteemed. 

Aural  medicine  has  of  late  undergone  a  very  great 
change,  since  the  discoveries  of  Trumbull,  in  the  appli- 
cations of  the  vapor  of  prussic  acid. 


DEAFNESS. 


639 


Forcing  air  and  tobacco,  and  other  vapors  into  the 
tube,  by  filling  the  mouth  with  them,  has  long  been 
practised* 

Dr.  Brown,  of  Cincinnati,  extols  the  following,  in 
many  varieties  of  deafness  : — 

Fill  a  four  ounce  vial  with  the  leaves  of  the  house- 
leek,  cork  it  tightly,  and  place  it  within  an  unbaked  loaf 
of  bread ;  when  the  bread  is  baked,  remove  the  bottle, 
and  there  will  be  found  a  liquid  of  a  soft,  oily  character, 
which  may  be  dropped  into  the  ear,  say  one  or  two 
drops,  every  night. 

Glycerin  is  highly  recommended  for  deafness,  in 
which  there  is  a  partial  or  total  absence  of  ceruminous 
(waxy)  secretion,  by  protecting  the  tympanum,  and 
gradually  restoring  the  parts  to  their  natural  condition ; 
it  is  said  likewise  to  cause  hearing,  in  cases  where  the 
tympanum  is  thickened  and  indurated,  or  whether  it 
be  in  a  sound  -state  or  destroyed  by  ulceration,  but  in 
this  last  not  permanent ;  and  where  there  is  a  hardness 
of  the  cerumen  (wax)  and  induration  of  the  tj^mpa- 
num,  it  has  proved  very  successful,  in  several  cases. 

The  plan  is  to  moisten  wool  with  the  glycerin,  pure 
or  diluted  with  water,  and  pass  it  into  the  ear.  This 
remedy  is  vouched  for  by  Prof.  Newton,  who  deservedly 
stands  eminent  in  the  profession. 

The  sap  of  walnut  or  hickory  wood  is  said  to  be  an 
infallible  remedy  for  pain  in  the  ear,  and  is  highly  re- 
commended for  deafness.  Take  a  small  stick,  put  it 
over  the  fire  or  stove,  and  place  a  vessel  under  each  end 
to  receive  the  sap ;  put  it  into  the  ear  on  cotton,  and 
repeat  occasionally. 


RETENTION  OF  THE  MENSES. 


DISEASES  OF  THE  ORGANS  OF  REPRODUCTION. 

AMENOERHCEA. 

Retention  of  the  Menses. — This  is  one  of  the  most  com- 
mon forms  of  menstrual  disease,  and  the  causes  produ- 
cing the  same  are  various  and  numerous.  There  is  at 
times  a  partial  and  again  a  total  obstruction.  Any 
cause  which  has  a  tendency  to  derange  the  general 
health  is  apt  to  produce  irregularities,  and  unless  reme- 
died, is  sure  to  lead  to  very  serious  consequences. 

When  there  is  complete  obstruction  of  the  menstrual 
secretion,  nature  makes  her  efforts  to  obtain  for  it  some 
other  outlet ;  if  these  efforts  of  nature  fail,  the  conse- 
quence may  be  fever,  pulmonic  disease,  spasmodic  affec- 
tions, hysteria,  epilepsy,  mania,  apoplexy,  or  green  sick- 
ness, according  to  the  general  habit  and  disposition  of 
the  patient. 

As  in  the  case  of  almost  any  suppressed  secretion,  it 
is  most  probably  connected  with  excessive  or  deficient 
vascular  action  in  the  secreting  organ,  or  it  may  result 
from  an  opposite  state.  Uterine  depression  may  be 
entirely  local,  or  may  depend  upon  a  debilitated  condi- 
tion of  the  system. 

Sometimes  the  uterine  affection  is  quite  local,  neither 
depending  upon  vascular  action  or  debility. 

Any  interruption  occurring  after  the  menses  have 
once  been  established  in  their  regular  course,  except 
when  occasioned  by  conception,  is  always  to  be  consi- 
dered as  a  case  of  suppression.  It  most  frequently  ari- 
ses from  accidental  circumstances,  such  as  taking  cold, 


RETENTION  OF  THE  MENSES. 


G41 


excessive  mental  excitement,  or  inactivity.  A  distin- 
guished author  affirms,  that  the  frequent  use  of  acids 
and  other  sedatives,  is  a  cause  which  evidently,  in  many 
instances,  produces  a  suppression  of  the  menses.  When 
the  menses  have  been  suppressed  for  any  considerable 
length  of  time,  it  not  unfrequently  happens  that  the 
blood,  which  should  have  passed  off  by  the  uterus,  being 
determined  more  forcibly  to  other  organs,  gives  rise  to 
haemorrhages ;  hence  it  is  frequently  poured  out  from 
the  nose,  stomach,  lungs,  and  other  parts  in  such  cases. 
At  first,  however,  febrile  or  inflammatory  symptoms 
appear,  the  pulse  is  hard  and  frequent,  the  skin  hot, 
and  there  is  a  severe  pain  in  the  head,  back  and  loins ; 
besides,  the  patient  is  likewise  much  troubled  with  cos- 
tiveness,  colic  pains,  and  dyspeptic  and  hysteric  symp- 
toms. 

The  class  of  symptoms  which  arise  from  this  affection, 
separate  and  apart  from  those  already  alluded  to,  are, 
languor  and  debility,  a  pale  and  sickly  expression  of  the 
countenance,  swellings  of  the  ankles,  various  nervous 
affections,  such  as  paroxysms  of  palpitation  of  the  heart, 
and  dyspnoea,  (difficulty  of  breathing,)  flatulent  and 
spasmodic  pain  in  the  bowels,  loss  of  appetite,  and  in 
relaxed  and  leucophlegmatic,  (a  dropsical  habit,)  leucor- 
rhaea,  (a  discharge  of  a  white,  yellowish  or  greenish 
mucous.)  In  subjects  predisposed  to  phthisis  pulmona- 
lis,  (consumption,)  or  some  other  local  or  general  disease, 
protracted  suppression  of  the  catemenial  evacuation  is 
always  particularly  dangerous,  from  its  strong  tendency 
to  develope  such  affections. 

Treatment. — When  the  uterus  ceases  to  secrete  from 
vascular  irritation,  and  at  the  same  time  accompanied 
with  a  general  fullness,  strong  pulse,  pain  in  the  back 
41 


CA2 


RETENTION  OF  THE  MENSES. 


or  head,  flushing  of  the  face,  &c.,  some  advise  bleed- 
ing. I  generally  omit  this,  and  give  an  active  cathar- 
tic, following  it  with  the  diaphoretic  powders,  letting 
the  patient  drink  at  the  same  time  an  ounce  or  two  of 
the  warm  infusion  of  the  antJwmis  cotula,  (wild  chamo- 
mile or  dog  fennel,)  and  immediately  immerse  the  feet 
in  warm  ley  water,  and  have  them  well  rubbed,  and  at 
the  same  time  I  apply  flannel  cloths,  wrung  out  of  hot 
water,  to  the  lower  portion  of  the  abdomen.  If  this 
application  should  not  subdue  the  general  excitement, 
it  might  be  necessary  to  apply  a  few  cups  to  the  same 
region. 

If  the  disease  should  be  dependent  upon  uterine 
depression,  or  otherwise  debilitative  condition  of  the 
general  system,  it  then  becomes  local  in  its  character, 
and  your  remedies  must  be  selected  accordingly.  If  the 
blood  is  in  fault,  its  vitiated  condition  must  be  corrected ; 
this  can  be  done  by  a  proper  course :  you  must  direct 
such  remedies  as  will  invigorate  the  system ;  the  sto- 
mach and  bowels  should  be  cleansed  and  stimulated  to 
a  healthy  action,  perspiration  must  be  promoted,  and, 
in  short,  every  secretion  and  excretion  of  the  system. 
If  the  stomach  is  in  a  morbid  condition,  let  an  emetic 
be  occasionally  given,  and  afterwards  a  dose  of  man- 
drake, both  of  which  may  be  repeated  as  occasion 
requires.  The  patient  may  then  take  the  folio  wing- 
tonic  bitters : 

^.    Prickly  ash  bark,  Sii. 

Wild  cherry  tree  bark,  gii. 

Seneca  snakeroot,  Si. 

Tansy,  Si. 

Aloes,  Bss. 

Devil's  bit,  Sii. 


RETENTION  OF  THE  MENSES. 


G43 


Pulverize.  To  every  two  ounces  of  the  powder,  add 
half  a  pint  of  boiling  water  and  one  quart  of  holland 
gin,  and  take  half  a  wine-glassful  three  or  four  times  a 
day.  This  should  be  continued  as  long  as  benefit  is 
derived.  In  debilitated  conditions,  iron  is  generally 
the  best  tonic ;  it  tends  to  improve  the  general  health, 
and  exerts  a  favorable  influence  upon  the  uterine  func- 
tions. 

The  late  Dr.  Dewees  recommended  in  strong  language 
the  following,  viz : 

IJi.    Pulverized  gum  guaiacum,  Si  v. 

Carbonate  of  soda  or  potash,  5ss. 

Pulverized  allspice,  gi. 

Diluted  alcohol,  1  pint. 

Digest  for  a  few  days.  Add  one  or  two  drachms  of 
hartshorn  to  every  four  ounces  of  the  tincture.  Dose, 
a  tea-spoonful  morning,  noon  and  night,  in  sweetened 
milk  or  wine;  gradually  increasing  the  dose. 

If  this  should  not  produce  the  desired  effect,  you  may 
employ  one  of  the  more  stimulating  emmenagogues. 
The  ammoniated  tincture  of  guaiacum,  in  doses  of  a 
drachm  three  or  four  times  a  day,  frequently  exerts  a 
very  happy  influence.  The  tincture  of  cantharides,  oil 
of  turpentine,  and  savin,  are  all  highly  emmenagogue 
and  frequently  serviceable. 

Eberle  extols  highly  the  smart  weed,  the  tincture  in 
tea-spoonful  doses  three  or  four  times  a  day,  or  an  in- 
fusion to  be  drank  freely. 

The  senicio  gracilis,  (life  root)  possesses  great  efficacy 
in  promoting  the  menstrual  secretion,  it  may  be  com- 
bined with  equal  parts  of  asarum,  (snake  root)  and  savin. 

The  alefris  farinosa,  or  star  grass,  exerts  a  peculiar 


644 


RETENTION  OF  THE  MENSES. 


influence  upon  the  female  organs,  it  imparts  tone  and 
energy  to  the  uterus,  and  is  a  very  reliable  vegetable 
agent.  Dose  of  the  powder,  five  to  ten  grains  three 
times  a  day — of  the  saturated  tincture  five  to  ten  drops 
in  water. 

The  pilulae  polygoni  compositce,  or  compound  pills  of 
smartweed,  are  very  highly  extolled  by  Dr.  King,  of 
Cincinnati,  he  uses  the  following  recipe,  viz : 

Ify.    Dried  sulphate  of  iron. 

Macrotin,  aa.  3i. 

Iridin  grs.  xv. 

Ext.  of  Smartweed,  q.  s. 

Mix  well  together,  and  divide  into  sixty  pills.  Dose, 
one  pill  every  two  hours. 

I  attach  some  remedies  which  appear  to  promote  the 
menstrual  evacuation,  solely  by  their  tendency  to  deter- 
mine blood  to  the  uterus;  and  if  there  should  be  irrita- 
tion or  inflammation,  the  following  remedies  would  be 
improper. 

1^.    Ext.  Gentian,  5i. 

Sulphate  of  iron,  grs.  iv. 
Gum  aloes  socc,      grs.  v. 

Divide  into  twenty  pills.    Dose,  one,  morning,  noon 


and  night.  Or, 

fy.    Pulv.  rhubarb,  9iv. 
Gum  aloes, 

Cayenne  pepper,  5i. 


Mucilage  of  gum  arabic,      q.  s. 

Mix.  Divide  into  twenty  pills.  Take  two  at  night 
on  going  to  bed. 


SUPPRESSION  OF  THE  MENSES. 


645 


^.    Powdered  savin,  3i- 
 Spanish  flies,  grs.  ii. 

Mix,  and  divide  into  four  powders.  Give  one  at  bed 
time. 

Some  speak  highly  of  the  following,  viz : 

Powdered  savin.  * 

 1  ginger,        aa.  3i. 

Sulphate  of  potassa,  5ii. 

Mix,  and  divide  into  six  powders.  Give  one  twice  a 
day. 

SUPPRESSIONS. 

Suppression  of  the  Menses. — I  cannot  well  draw  the 
distinction  between  this  and  retention  of  the  menses; 
it  is,  in  young  females,  frequently  suppressed  between 
the  ages  of  twelve  and  sixteen,  and  at  this  age  it  con- 
stitutes a  critical  period  in  their  life,  and  much  depends 
upon  having  this  discharge  established;  it  is  sometimes 
attended  with  very  painful  and  serious  consequences, 
frequently  undermining  and  impairing  the  constitution. 
The  causes  and  symptoms  are  well  stated  by  a  distin- 
guished author. 

"  The  remote  cause  of  this  complaint  is  most  fre- 
quently suppressed  perspiration;  and  it  may  arise,  in 
part,  from  an  inactive  and  sedentary  life,  and  such 
habits  as  are  peculiar  to  the  higher  classes  of  society, 
particularly  in  cities  and  towns.  The  proximate  cause 
of  it  seems  to  be  a  want  of  power  in  the  system,  arising 
from  inability  to  propel  the  blood  into  the  uterine  vessels 
with  sufficient  force  to  open  their  extremities  and  allow 
a  discharge  of  blood  from  them. 


646 


SUPPRESSION  OF  THE  MENSES. 


Symptoms. — Heaviness,  indifference  to  motion,  fatigue 
on  the  least  exercise,  palpitations  at  the  heart,  pains  in 
the  back,  loins,  and  hips,  flatulence,  acidities  in  the 
stomach  and  bowels,  costiveness,  a  preternatural  appe- 
tite for  chalk,  lime,  and  various  other  absorbents,  to- 
gether with  many  dyspeptic  symptoms.  As  it  advances 
in  iis  progress  the  face  becomes  pale,  and  afterwards 
assumes  a  yellowish  hue,  even  verging  upon  green, 
whence  it  has  been  called  green  sickness;  the  lips  lose 
their  rosy  color,  the  eyes  are  encircled  with  a  livid  areola, 
the  whole  body  has  an  unhealthy  appearance,  with  every 
indication  of  a  want  of  power  and  energy  in  the  consti- 
tution; the  feet  are  affected  with  swellings,  the  breath- 
ing is  much  hurried  by  any  great  exertion  of  the  body, 
the  pulse  is  quick,  but  small,  and  the  person  is  liable  to 
a  cough,  and  to  many  of  the  symptoms  of  hysteria. 
Sometimes  a  great  quantity  of  pale  urine  is  discharged 
in  the  morning,  and  not  unfrequently  hectic  fever  attend^. 
In  cases  of  a  more  chronic  character  c  there  is  a  continued 
though  variable  state  of  sallowness,  yellowness,  darkness, 
or  a  wan,  squalid,  or  sordid  paleness  of  complexion,  or 
a  ring  of  darkness  surrounding  the  eyes,  and  extending 
perhaps  a  little  towards  the  temples  and  cheeks.' " 

In  regard  to  treatment,  I  recommend  that  which  I* 
have  advised  in  retention  of  the  menses.    Some,  how- 
ever, speak  highly  of  the  hydriodate  of  potassa  in  solu- 
tion, with  daily  bathing  of  the  feet.    I  have  no  doubt 
in  many  instances  it  would  be  serviceable. 

The  patient  should  never  expose  herself  to  the  in- 
clemencies of  the  season.  She  should  by  all  means 
avoid  getting  wet.  The  chalybeate  waters  will  be 
found  beneficial. 


DIFFICULT  MENSTRUATION. 


647 


"  If  there  should  be  violent  pain  in  the  bowels  apply 
a  heated  brick." 

The  diet  should  be  light  and  easy  of  digestion. 

DYSMENORRHEA. 

Difficult  Menstruation. — Dysmenorrhoea  differs  from 
amenorrhea,  where  menstruation,  although  not  wholly 
suppressed,  is  nevertheless  difficult,  and  attended  with 
acute  and  severe  pain,  which  generally  commences 
a  day  or  two  before,  but  sometimes  immediately  preced- 
ing the  discharge.  The  pain  is  most  generally  confined 
to  the  back,  loins  and  lower  portion  of  the  abdomen, 
sometimes  intermittent ;  and  it  differs  in  degree  of  inten- 
sity from  severe  and  almost  constant  soreness,  to  lanci- 
nating and  darting  pain,  and  sometimes  attended  with 
colic.  It  is  generally  attended  with  more  or  less  con- 
stitutional disturbance,  accompanied  with  a  weakened 
action  of  the  vessels  of  the  uterus.  There  is  frequently 
scalding  pain  on  passing  the  urine  ;  as  soon,  however,  as 
the  menses  makes  its  appearance,  the  pains  mitigate  and 
gradually  pass  away. 

"  Dysmenorrhoea  may  occur  with  different  conditions 
of  the  menstrual  discharge.  Sometimes  it  is  as  copious 
His  usual,  at  others  to  a  greater  extent ;  but,  more  fre- 
quently it  is  diminished  in  quantity." 

We  have  two  or  three  varieties  of  dysmenorrhoea, 
evidently  arising  from  different  causes ;  in  one  variety 
the  discharge  is  evidently  mixed  with  shreds  of  coagu- 
lable  lymph,  this  variety  is  generally  attended  with 
febrile  excitement  and  more  or  less  inflammation.  This 
latter  will  distinguish  it  from  the  neuralgic  form. 

Dr.  Oldham  mentions  retroversion  of  the  womb  as  a 
sequela  of  the  membranous  form  of  dysmenorrhoea.  The 
change  occurs  slowly,  and  requires  several  months  to  be 


048 


DIFFICULT  MENSTRUATION. 


effected.  The  texture  of  the  uterus  becomes  altered. 
In  a  recent  congestion,  the  posterior  wall  is  soft,  com- 
pressible and  painful  to  the  touch,  but  after  repeated 
engorgments  it  becomes  harder,  more  solid,  and  very 
much  like  a  fibrous  growth.  The  principal  symptoms 
of  this  large  and  retro  verted  uterus  are  an  additional 
weight  in  the  lower  part  of  the  abdomen,  a  painful  sense 
of  pressure  about  the  sacrum.  TtLere  is  pain,  also,  on 
sitting  down,  with  a  sensation  as  if  some  body  was 
pressed  upwards. 

Causes. — Difficult  menstruation,  like  suppressed,  is 
frequently  induced  by  powerful  mental  emotion,  "  or  by 
anything  which  interferes  with  the  process ;  hence,  it 
may  be  owing  to  cold.  We  meet,  however,  with  cases 
in  which  it  is  difficult  to  discover  the  precise  causes,  and 
in  which  the  female  at  every  monthly  period  suffers 
excessively,  and  is  only  relieved  by  the  cessation  of  the 
menses. 

Treatment. — Our  first  attention  must  be  directed  to 
removing  the  cause,  if  it  can  be  ascertained.  Cold  gene- 
rally seems  to  be  the  principal  cause,  and  our  treat- 
ment will  necessarily  resolve  itself  into  that  which  is 
proper  during  the  interval,  and  that  required  during  the 
attack.  And  it  is  almost  impossible  to  follow  any  pre- 
cise course.  Where  it  is  the  result  of  cold,  you  will 
generally  find  the  skin  dry,  and  the  patient  laboring 
under  a  little  febrile  excitement.  For  the  purpose  of 
producing  a  determination  to  the  surface,  remedies 
should  be  directed  to  the  skin.  Under  these  circum- 
stances we  advise  a  hip  bath,  with  some  of  the  bitter 
herbs  placed  in  it,  such  as  tansy,  hoarhound,  and  hops. 
The  patient  should  use  it  as  hot  as  it  can  be  borne,  and 
at  the  same  time  drink  of  a  strong  tea  of  lady-slipper 


DIFFICULT  MENSTRUATION. 


649 


and  snake  root.  After  she  is  removed  from  the  bath, 
the  herb  fomentations  should  be  applied  warm  to  the  lower 
portion  of  the  abdomen.  "  The  condition  of  the  system, 
after  you  have  allayed  pain  by  the  bath,  must  be  nar- 
rowly investigated,  and  if  the  disease  be  owing  to  unu- 
sual impressibility,  accompanied  with  want  of  tone  in 
the  system  generally,  a  plan  of  treatment  is  required 
which  is  adapted  to  improve  the  general  health.  With 
this  view  the  tonics  and  chalybeates,  as  recommended 
in  amenorrhoea,  (which  see)  will  be  advisable ;  the  cold 
bath  and  exercise  will  be  conducive  to  restoring  the 
general  health.  Immediately  before  the  expected  period 
it  may  be  advisable  to  make  a  new  impression  on  the 
nervous  system  by  full  doses  of  opiates.  Where,  on  the 
other  hand,  the  dysmenorrhoea  is  accompanied  with 
inflammatory  symptoms,  the  antiphlogistic  regimen 
(regimen  opposed  to  inflammation)  should  be  adopted, 
in  connection  with  cups  to  the  lohis  and  the  warm  bath 
as  advised. 

As  a  palliative,  eight  or  ten  grains  of  camphor  every 
hour  will  have  a  tendency  to  subdue  the  pain. 

Some  have  used  with  great  success,  equal  parts  of 
balsam  copaiba,  spirits  of  nitre  and  oil  of  juniper. 

Doctor  Fothergill  states  the  following  process  will  re- 
lieve in  most  instances ;  with  the  first  sensations  of 
pain,  she  must  take  a  grain  of  opium  every  hour,  until 
the  pain  ceases,  and  advises  a  recumbent  position,  and 
the  patient  to  drink  moderately  of  any  diluting  liquor, 
as  herb  teas,  weak  whey,  or  thin  broth.  When  the 
time  is  past,  a  course  of  chalybeate  bitters  in  small 
doses,  may  be  continued  till  within  a  few  days  of  the 
return,  and  the  bowels  should  be  kept  in  a  soluble  con- 
dition.   The  diaphoretic  powders  will  be  found  useful ; 


650 


DIFFICULT  MENSTRUATION. 


and  it  is  said  Lot  bricks,  enclosed  in  flannel  wet  with 
vinegar,  or  dry  hot  salt  applied  to  the  bowels,  soon  re- 
lieve the  pain. 

In  instituting  a  course  of  treatment  for  a  radical 
cure,  particular  attention  must  be  paid  to  the  general 
state  of  the  system.  The  tartrate  of  iron,  fifteen  or 
twenty  grains  three  or  four  times  daily,  has  been  highly 
recommended.  Also  seneka  snake  root,  ancl  the  vola- 
tile tincture  of  guaiacum,  have  gained  some  celebrity 
in  .the  relief  of  this  painful  disease. 

Where  the  pain  is  corifined  to  the  lower  part  of  the 
abdomen,  and  almost  immediately  over  the  uterus,  you 
will  derive  much  benefit  from  the  extract  of  belladonna 
and  sulphate  of  zinc,  (white  vitriol,)  five  grains  of  the 
former  and  twenty  grains  of  the  latter,  divided  into 
twenty  pills,  and  give  one  immediately  on  the  accession 
of  the  pain,  and  repeated  every  two  or  three  hours  until 
complete  relief  is  obtained.  If  the  patient  is  of  a  ple- 
thoric and  full  habit,  substitute  ten  grains  of  ipecac,  for 
the  zinc.  Make  the  same  number  of  pills,  and 
administer  as  before  directed. 

The  inner  bark  of  the  cotton  root  is  said  to  exert  a 
fine  influence  in  this  and  other  uterine  diseases.  Take 
four  ounces  of  the  inner  bark  of  the  root,  boil  in  a  quart 
of  water  to  a  pint ;  the  dose,  one  or  two  ounces  every 
half  hour  or  hour. 

A  strong  decoction  of  the  figwort  root  drank  freely, 
is  said  to  restore  the  lochial  discharge  when  suppressed, 
and  almost  a  specific  in  relieving  pains  attendant  upon 
difficult  menstruation. 

In  this  variety  of  painful  uterine  disease,  the  following 
recipe  has  acquired  considerable  celebrity,  viz  : 


DIFFICULT  MENSTRUATION. 


G51 


^.    Oil  of  chamomile,  pi- 
Ethereal  oil  of  hops,  oiss. 
Dissolved  in  sulphuric  ether,  f.gss. 

Give  it  in  doses  from  thirty  to  sixty  drops,  every 
three  or  four  hours. 

A  very  distinguished  author  asserts  that  quinine  in 
dysmenorrhoea,  in  conjunction  with  extract  of  strammo- 
nium,  (Jamestown  weed,)  or  belladonna  and  macrotin, 
is  almost  a  specific,  if  it  possess  but  half  the  virtues 
that  is  attributed  to  this  compound,  it  will  be  very 
valuable ;  in  the  inflammatory  form  of  dysmenorrhoea, 
I  would  not  be  inclined  to  use  it,  though  the  addition  of 
morphine  in  such  cases,  might  counteract  any  injurious 
consequences. 

The  oil  of  chamomile  alone,  in  doses  from  five  to 
fifteen  drops,  will  frequently  relieve  in  this  painful 
disease. 

The  Southernwood  (of  the  south  of  Europe)  enjoys 
the  confidence  of  many  in  this  disease,  viz : 

ty.    Southernwood,  3vi. 
Boiling  water,     1  pint. 

Digest  for  two  hours,  and  strain.    Given  frequently. 

The  compound  ergot  pills  were  favorites  with  the  dis- 
tinguished Dewees,  his  recipe  was  as  follows,  viz  : 

fy.    Powdered  ergot,  5ss. 
Extract  of  gentian,  oi. 

Rub  together,  and  make  fifteen  pills.  Dose,  one  pill 
three  times  a  day. 


652 


FLUOR  ALBUS. 


WHITES. 

LeucorrJwea  or  Fluor  Albus. — This  affection  is  the 
result  of  a  morbid  secretion  and  discharge  from  the 
vagina ;  and  it  is  said  to  be  the  most  common  disease  to 
which  females  are  subject.  There  are  evidently  two 
varieties,  for  there  is  no  doubt  that  a  similar  discharge 
frequently  takes  place  from  the  lining  membrane  of  the 
uterus,  and  I  have  seen  it  exist  at  the  same  time  with 
vaginal  leucorrhcea.  The  source  of  the  discharge  in  this 
latter  variety,  is  indicated  by  its  increase  immediately 
before  or  after  a  monthly  period,  by  pain  in  the  uterus, 
and  by  the  discharge  assuming,  at  those  times,  a  more 
purulent  appearance,  facts  which  are  said  not  to  hold 
good  with  regard  to  vaginal  leucorrhcea. 

Dr.  Eberle  says  the  causes  of  vaginal  leucorrhcea  are 
very  various.  In  general,  whatever  is  capable  of  relax- 
ing the  system,  as  a  luxurious,  indolent  or  sedentary 
manner  of  living,  habitual  exposure  to  a  humid  atmos- 
phere, and  want  of  pure  air  and  wholesome  nourishment, 
are  especially  calculated  to  predispose  to  the  occurrence 
of  this  disease.  Females  of  a  relaxed  and  nervous  habit 
of  body  are  particularly  liable  to  this  peculiar  discharge. 
Everything  which  is  capable  of  causing  irritation  in  the 
mucous  membrane  of  the  vagina  may  excite  it.  The 
following  are  the  most  common  and  powerful  exciting 
causes  of  this  disease.  Excessive  venereal  indulgence, 
difficult  labor,  or  the  irritation  caused  by  the  employ- 
ment of  obstetrical  instruments.  Frequent  and  profuse 
menorrhagia,  (immoderate  flow  of  the  menses,)  fre- 
quently follow  the  discharge.  Prolapsus  uteri,  (falling 
of  the  womb,)  is  almost  invariably  attended  with  more 
or  less  leucorrheal  discharge,  in  consequence  of  the  con- 


FLUOR  ALBUS. 


653 


tinued  vaginal  irritation  by  the  fallen  uterus.  The 
abuse  of  emmenagogues  often  gives  rise  to  obstinate 
leucorrhoea.  Self-pollution  is,  by  many  of  the  German 
authors,  regarded  as  one  of  the  most  frequent  sources  of 
this  disagreeable  affection.  Piles,  diseases  of  the  uterus, 
tumors  pressing  upon  the  vagina,  mechanical  injuries, 
and  the  intemperate  use  of  spirituous  liquors,  may  all 
give  rise  to  the  disease. 

The  symptoms,  also,  are  described  by  Eberle  with  so 
much  accuracy  that  I  will  still  continue  to  follow  him. 

It  is  asserted  that,  in  some  cases,  the  discharge  is  so 
acrid  as  to  produce  symptoms  on  those  who  have  con- 
nection with  the  woman  somewhat  similar  to  the  vene- 
real disease,  causing  excoriations  about  the  penis,  and  a 
discharge  from  the  urethra.  The  appetite  is  very  poor, 
and  the  feet  generally  swell. 

Symptoms. — The  disease  is  ushered  in  by  an  irregular 
discharge  of  a  fluid  from  the  uterus  and  vagina,  not 
alike  in  all  women,  differing  much  in  color,  being  of  a 
white,  green,  yellow  or  brown  color,  and  in  many 
instances  the  discharge  has  the  appearance  of  the  com- 
mon vaginal  mucous,  and  again  I  have  seen  it  resemble 
starch  mixed  with  a  mucilaginous  substance.  Dr.  Eber- 
le says,  "  Sometimes  it  presents  the  appearance  of  pus, 
possessing  an  acrid  and  corroding  quality.  These  dif- 
ferences in  the  appearance  of  the  discharge  indicate  the 
relative  degrees  of  violence  of  the  affection. 

In  point  of  quantity,  also,  great  diversity  occurs  in 
different  cases.  In  some  instances  it  is  so  moderate  as 
hardly  to  occasion  any  inconvenience,  whilst  in  others 
it  is  extremely  copious.  When  the  discharge  is  very 
profuse,  and  of  an  acrid  quality,  the  external  parts  of 
the  genital  organs  become  red,  swollen  and  painful,  and 


054 


FLUOR  ALBUS. 


this  state  of  irritation  usually  extends  into  the  vagina, ' 
and  even  to  the  mouth  of  the  uterus,  rendering  the 
whole  passage,  and  especially  the  os  tincae,  (the  mouth 
of  the  uterus,)  very  tender  to  the  touch. 

When  the  disease  is  suffered  to  continue,  it  seldom 
fails  at  last  to  make  an  injurious  impression  upon  the 
whole  system.  The  countenance  at  length  becomes  pal- 
lid and  sickly,  the  eyes  dull,  languid,  and  surrounded 
by  a  blueish  or  lead-colored  circle ;  flushing  of  the  face 
is  alternated  by  a  ghastly  paleness ;  the  eye-lids  tumid ; 
the  mind  dejected,  discontented  and  fretful ;  the  whole 
system  debilitated  and  sluggish;  the  extremities  cold. 
In  process  of  time  the  feet  and  ankles  swell ;  the  pulse 
small  and  feeble,  or  small,  frequent  and  somewhat 
corded ;  the  digestive  functions  deranged,  attended  with 
acrid  eructations,  heart-burn,  pains  in  the  back,  loins 
and  lower  extremities ;  colic  pains  in  the  lower  part  of 
the  abdomen;  constipation  and  diarrhoea,  and  pain  in 
voiding  the  urine. 

By  degrees,  the  discharge  usually  becomes  more  and 
more  copious  and  purulent;  the  relaxation  and  languor  of 
the  muscular  system  increase,  whilst  the  pulse  becomes 
more  frequent  and  irritated.  At  length,  in  aggravated 
cases,  the  slightest  bodily  exertions  give  rise  to  hurried 
respiration  and  palpitation  of  the  heart;  and  in  instances 
of  great  severity,  the  powers  of  digestion  at  last  become 
exceedingly  weak;  nausea  and  vomiting  frequently 
come  on,  and  finally  hectic  and  rapid  emaciation  arise. 

Much  discussion  has  been  had  in  regard  to  the  cause ; 
the  terms  debility  and  relaxation  may  most  assuredly 
be  correctly  applied  to  this  disease,  in  a  great  majority 
of  cases.  The  languor,  general  weakness  and  relaxa- 
tion, as  well  as  the  feeble  and  sluggish  pulse,  so  fre- 


FLUOR  ALBUS. 


055 


quently  noticed  in  profuse  leucorrhoea,  are  sufficient 
evidence  of  the  correctness  of  this  observation. 

Treatment. — In  cases  of  almost  any  grade,  you  will 
find  the  cure  difficult,  requiring  much  energy  and  perse- 
verance in  the  application  and  administration  of  reme- 
dies. The  general  health  soon  becomes  involved,  and 
one  of  your  primary  objects  will  be  to  restore  the  gene- 
ral health,  and  impart  tone  and  energy  to  the  system ; 
this  point  of  the  treatment  must  be  specially  attended  to. 

Where  the  pulse  is  active,  and  the  general  habit  full, 
you  should  commence  your  treatment  with  a  purgative, 
accompanying  it  with  low  diet,  which,  in  general,  will 
be  quite  adequate  to  reduce  the  irritation  of  the  system ; 
if  there  is  a  loaded  state  of  the  bowels,  the  purgative 
must  be  repeated,  and  if  there  is  functional  disorder  of 
the  liver,  you  must  give  podophyllin  as  an  alterative ; 
this  will  be  best  accomplished,  by  administering  in 
quarter  or  half  gram  doses,  repeated  at  intervals  of  two 
or  three  hours,  until  the  secretions  of  the  liver  are  fully 
established.  This  should  then  be  followed  by  the  fol- 
lowing recipe,  viz : — 

I$5.    Sweet  spts.  nitre,  §ii. 


Mix  these  together,  and  add  one  scruple  of  camphor. 

Dose,  tea-spoonful,  given  in  mucilage  of  gum  arabic 
or  herb  tea,  three  or  four  times  a  day ;  and  it  should  be 
taken  on  an  empty  stomach. 

In  prescribing  more  directly  for  the  removal  of  the 
disease,  particular  attention  must  be  paid  to  the  actual 
condition  of  the  mucous  membrane  of  the  vagina. 


Balsam  copaibse, 
Oil  of  almonds, 
Spts.  of  turpentine, 


65G 


FLUOR  ALBUS. 


When  the  discharge  is  white  and  opaque,  your  local 
applications  must  be  such  as  will  have  a  tendency  to 
lessen  irritation,  and  for  this  purpose  I  advise  warm 
water  to  be  injected  four  or  five  times  a  day  for  three  or 
four  days ;  by  following  this  plan,  in  connection  with  a 
vegetable  diet,  you  will  soon  be  enabled  to  resort  with 
propriety  to  the  means  more  directly  calculated  to 
remove  the  irritation  upon  which  the  discharge  depends ; 
and  this  cannot  be  better  accomplished  than  by  using  a 
female  syringe,  and  injecting  the  following  mixture,  viz  : 
fy.    Sugar  of  lead,  3i- 
Sul.  zinc,  (white  vitriol,)  3i- 
Rain  water,  Oi. 

A  syringe  half  full,  should  be  injected  up  the  vagina 
four  or  five  times  a  day. 

Your  treatment  must  be  adapted  to  the  actual  grade 
of  vaginal  irritation,  the  exciting  causes,  and  peculiar 
condition  of  your  patient ;  it  is  sometimes  essential  to 
give  the  restorative  wine  bitters,  and  to  wear  a  strength- 
ening plaster  across  the  loins ;  this  treatment  is  adapted 
to  the  languid  and  relaxed  patient,  who  at  the  same 
time  should  use  the  following  injection,  viz : 

fy.    White  oak  bark. 

Sumach  berries  or  bark. 
Witch  hazel  bark. 
Hemlock  bark. 
Bruise  or  pulverize,  and  make  a  strong  concentrated 
decoction;  to  every  pint  add  a  tea-spoonful  of  pul- 
verized alum,  and  inject  two  or  three  times  a  day. 

The  tincture  of  cantharides,  in  doses  from  twenty  to 
thirty  drops,  three  times  a  day,  is  highly  spoken  of. 
Dr.  Beach  extols  very  highly  the  following : — 


FLUOR  ALBUS. 


657 


fy.    Tinct.  aloes, 

Muriated  tinct.  of  iron, 


Si. 
oii. 


Dose,  forty  drops,  three  times  a  day,  in  a  little  water. 

Alum  I  have  used  with  decided  advantage  in  this 
disease,  in  combination  with  a  strong  decoction  of  marsh 
mallows. 

In  cases  where  the  system  is  entirely  free  from  in- 
flammatory irritation  in  the  affected  parts,  the  spirits  of 
turpentine  will  be  found  a  remedy  of  much  value,  espe- 
cially if  used,  whilst  at  the  same  time  the  patient  injects 
the  following : — 

Make  a  weak  solution  of  the  acetate  of  iron,  add  a 
few  drops  of  kreosote;  inject  a  small  portion  two  or 
three  times  a  day. 

Some  speak  highly  of  this  preparation  to  be  admin- 
istered internally,  in  doses  from  five  to  twenty  drops,  in 
water. 

Dewees  extols  alum  and  nitre,  and  says  he  has  effected 
cures  in  very  obstinate  cases,  by  giving  five  grains  of 
the  former,  with  ten  of  the  latter,  three  times  a  day. 

The  macrotin,  of  late,  is  highly  and  justly  recom- 
mended for  the  cure  of  this  disease,  by  a  very  distin- 
guished physician. 

The  late  Prof.  T.  V.  Morrow  says  of  this  article : 
For  several  months  I  have  used  the  macrotm  very 
extensively,  in  the  treatment  of  a  numerous  class  of 
female  diseases,  for  the  successful  treatment  of  which  I 
had  for  many  years  previous  been  in  the  habit  of  depend- 
ing mainly  on  the  macrotrys  racemosa,  either  in  the 
form  of  infusion,  decoction,  or  tincture.  My  confidence 
in  the  value  of  the  macrotrys  racemosa,  I  am  free  to 
confess,  has  been  such  as  to  induce  me  to  use  perhaps  a 
larger  quantity  of  this  medicine,  for  the  last  sixteen 


42 


G58 


FLUOR  ALBUS. 


years,  than  any  practitioner  in  the  United  States, 
giving  it  a  more  extended  range  of  application  in 
the  treatment  of  disease,  and  relying  with  more  confi- 
dence on  its  ultimate  efficiency,  than  any  of  my  medical 
friends.  My  experience  in  the  use  of  this  article,  during 
the  period  named,  has  been  mostly  confined  to  cases  of  leu- 
corrhoea,  menorrhagia,  prolapsus  uteri,  threatened  miscar- 
riage, dysmenorrhoea,  and  barrenness,  or  sterility,  in  all 
of  which  cases  I  have  obtained  the  most  satisfactory 
results  from  the  cimicifuga,  or  macrotrj^s ;  but  deeming 
the  macrotin  a  more  convenient  form  of  the  medicine 
for  practical  use,  and  believing  it  to  contain  the  virtues 
of  the  article  from  which  it  is  obtained,  I  have  accord- 
ingly used  it  in  similar  cases,  with  results  thus  far  which 
justify  the  conclusion  that  it  will  be  found  a  satisfactory 
substitute. 

My  experience  in  the  use  of  the  macrotin  has  demon- 
strated to  my  mind  that  there  is  a  slight  difference  in 
the  modus  operandi  of  this  form  of  the  medicine,  when 
compared  with  the  usual  forms  in  which  the  macrotrys 
racemosa  has  been  used.  That  difference  principally 
consists  in  the  increased  liability  of  the  latter  to  pro- 
duce a  heavy,  dull,  and  aching  sensation  in  the  fore- 
head, in  connection  with  a  feeling  of  dizziness,  while  the 
former  appears  to  manifest  a  greater  tendency  to  pro- 
duce aching,  and  somewhat  painful  sensations  in  the 
joints  and  limbs  generally.  I  have  usually  given  the 
macrotin  in  the  form  of  pills,  prepared  by  adding  a  small 
quantity  of  pulverized  castile  soap,  enough  to  make  the 
mass  properly  adhesive,  and  forming  it  into  pills  of  the 
ordinary  size,  and  giving  one  every  three  hours  during 
the  day,  in  all  the  various  cases  above  mentioned,  when- 
ever they  have  come  under  my  care,  since  I  commenced 


FLUOR  ALB  US. 


659 


its  use.  In  nearly  all  these  cases  it  has  proved  singu- 
larly beneficial,  thus  affording  the  gratifying  evidence 
that  it  will  soon  become  one  of  the  most  popular  and 
valuable  articles  of  the  materia  medica. 

Another  Professor,  in  speaking  of  niacrotin,  remarks  : 
"  The  medicine  is,  in  its  effects,  essentially  the  same 
as  the  macrotrys,  (cimicifuga,  of  the  U.  S.  Dispensatory.) 
It  is  particularly  useful  in  chronic  rheumatic  affections, 
and  in  female  diseases.  In  leucorrhcea  and  dysmenor- 
rhoea,  as  well  as  menorrhagia,  it  is  invaluable.  It  should 
be  used  in  order  to  get  its  best  effects,  to  the  extent  of 
producing  its  specific  constitutional  symptoms,  i.  a 
peculiar  dizziness,  fullness  and  dull  aching  of  the  head, 
and  more  or  less  aching  in  the  joints.  This  effect  should 
be  produced  every  day  (slightly)  during  the  treatment, 
until  the  disease  is  removed.  By  this  treatment,  and  the 
use  of  hip  baths,  leucorrhcea  will  often  be  cured  in  a 
week  or  ten  days,  without  any  other  remedy." 

I  have  already  observed  that  a  similar  discharge  may 
take  place  from  the  lining  membrane  of  the  uterus,  either 
alone  or  along  with  the  Vaginal  leucorrhcea.  When  such 
is  the  case  it  is  not  benefitted  by  astringent  injections, 
like  the  vaginal  discharges.  Dr.  Kennedy  treats  it  by 
the  nitrate  of  silver  or  the  fluid  nitrate  of  mercury 
applied  directly  to  the  part.  This  requires  some  skill 
in  the  physician  in  adapting  instruments  for  its  applica- 
tion. 

The  acute  form  requires  cupping  on  the  loins,  with 
the  hip  bath  and  warm  emollient  injections  into  the 
vagina  and  rectum  ;  and,  after  the  active  stage  has  passed 
away,  or  at  any  time  during  the  chronic  form,  counter- 
irritants  may  be  applied  to  the  sacrum,  (the  lower  por- 
tion of  the  spine)  croton  oil  or  dry  cups.  Internal 


660 


FALLING  OF  THE  WOMB. 


remedies  are  generally  of  but  little  use,  with  the  excep- 
tion of  such  as  are  directed  to  the  accompanying  condi- 
tion of  the  constitution,  chalybeates,  for  example.  It 
may  be  proper  to  remark,  however,  that  of  late  ergot  is 
said  to  have  succeeded.  It  may  be  given  in  doses  of 
five  grains  three  times  a  day.  Ryan  recommends  the 
following : 

Ergot,  9ii. 
Pulv.  cubebs,  Sss. 
Pulv.  cinnamon,  3ss. 
Loaf  sugar,  3i. 
Divide  into  ten  powders.    Give  one  three  or  four 
times  a  day. 

In  the  latter  stage  of  the  disease,  gentle  astringent 
injections,  similar  to  those  advised  under  vaginal  leucor- 
rhoea  may  be  used.  Attention  to  cleanliness  is  essen- 
tial." 

Strong  tea  and  colfee  are  prohibited.  The  patient 
should  take  exercise  sufficient  to  promote  a  healthy 
action  of  the  bowels  and  keep  them  regular.  This  is 
essential  in  any  form  of  the  disease. 

PROLAPSUS  UTERI. 

Falling  of  the  Womb.— Falling  of  the  womb  is  a  dis- 
placement of  the  uterus  from  its  natural  situation,  and 
when  we  consider  how  slightly  it  is  connected  with 
other  parts,  it  may  excite  some  degree  of  surprise  that 
the  displacement  does  not  more  frequently  occur.  It  is 
placed  at  the  upper  part  of  the  pelvis,  with  its  neck 
resting  over  the  cavity  of  the  vagina.  The  descent  of 
the  uterus  into  the  vagina,  is  the  most  frequent  among 
females  who  stand  much  in  the  erect  posture.  So  long, 
therefore,  as  the  relations  of  these  parts  to  each  other 


FALLING  OF  THE  WOMB. 


661 


are  natural,  the  uterus  will  remain  in  its  proper  posi- 
tion ;  but  if  the  vagina  becomes  wider,  and  the  uterus 
heavier  than  natural,  then  the  latter  begins  to  sink  into 
the  cavity  of  former.  This  is  the  state  of  the  parts 
after  parturition.  The  uterus  is  then  preternaturally 
large  and  heavy,  and  having  lately  contained  the  foetus 
and  its  appendages,  some  time  must  elapse  before  it  is 
contracted  to  its  original  size.  The  vagina  also,  is  at 
this  time  much  wider  than  is  natural,  and  having 
recently  admitted  the  passage  of  a  child  through  it, 
this  part  also,  will  require  some  days  to  resume  its 
natural  capacity.  Sitting  up  prematurely  in  the  erect 
position  after  delivery,  very  much  disposes  the  uterus 
to  this  accident ;  and,  in  some  patients,  even  when  in 
the  horizontal  position,  a  trifling  exertion,  such  as  strain- 
ing at  stool,  &c,  will  be  sufficient  to  occasion  prolapsus. 
There  is  no  question  that  nineteen  cases  in  twenty 
arise  from  sitting  up  too  soon  after  delivery.  It  is, 
however,  by  no  means  invariably  connected  with  partu- 
rition ;  on  the  contrary,  it  appears  sometimes  to  occur 
from  mere  relaxation^  the  parts,  as  in  some  emaciated 
subjects,  without  any  obvious  deviation  from  their 
natural  size  or  structure.  This  happens  either  partially 
or  wholly ;  the  womb  descends  into  the  vagina,  and 
sometimes  protrudes  entirely  out,  which  causes  much 
distress ;  pains  in  the  back,  groin,  bearing  down  with 
great  weakness,  and  frequently  attended  with  very 
nervous  symptoms. 

The  uterus  generally  presses  both  behind  and  before, 
occasioning  a  difficulty  in  passing  both  urine  and  fasces. 
These  are  generally  the  local  symptoms.  The  constitu- 
tional symptoms  are — a  disordered  state  of  the  stomach 
and  of  the  whole  general  system. 


6G2 


FALLING  OF  THE  WOMB. 


Treatment. — Beach  says  a  broad  bandage  should  be 
worn  over  the  lower  part  of  the  bowels,  and  drawn 
moderately  tight ;  you  should,  however,  before  applying 
the  bandage,  be  certain  that  the  womb  is  in  its  proper 
place ;  a  strengthening  plaster  should  be  applied  to  the 
back,  the  restorative  wine  bitters  used,  the  bowels  kept 
regular,  and  the  surrounding  parts  bathed  twTice  a  day 
with  salt  and  water.  A  decoction  of  oak  bark,  to 
which  add  a  little  alum,  may  be  injected  into  the  womb 
or  vagina,  once  or  twice  a  day. 

I  advise  the  new  patent  india  rubber  pessary,  which 
you  inflate  with  air ;  after  its  introduction,  it  produces 
very  little  irritation  to  the  mucous  membrane  of  the 
vagina,  and  by  using  it  constantly,  and  observing  a 
horizontal  position  for  a  week  or  two,  with  the  applica- 
tion of  cold  water  to  the  abdomen, '  will  in  nine  cases 
out  of  ten,  give  relief. 

I  advise  also,  the  abdominal  supporter. 

"  In  chronic  cases  of  procidentia  uteri,  you  must 
return  the  displaced  uterus,  and  apply  the  pessary  be- 
fore alluded  to,  which  must  be  r^ularly  worn  ;  in  con- 
junction with  this,  you  must  endeavor  to  induce  a  con- 
traction of  the  vagina,  by  the  employment  of  astringent 
injections  or  lotions,  as  one  drachm  of  alum  dissolved 
in  half  a  pint  of  the  decoction  of  pomegranate  bark, 
which  may  be  applied  three  times  a  day.  These  cases 
are  seldom  cured ;  but  when  the  complaint  is  recently 
discovered,  that  is,  writhin  a  month  or  six  weeks  after 
its  occurrence,  a  cure  may  be  expected.  If  pregnancy 
should  take  place,  the  uterus,  of  course,  soon  after 
the  third  month  ascends  spontaneously,  into  the  cavity 
of  the  abdomen ;  and  if  the  case  as  formerly  mentioned, 
is  well  managed  after  delivery,  a  cure  is  probable. 


SCURVY. 


663 


Here  you  Lave  two  objects  of  attention  :  the  first,  to 
insure  the  most  strict  observance  of  the  recumbent 
posture,  until  the  uterus  has  resumed  .its  natural  size 
and  weight ;  and  the  second,  to  aid  the  contraction  of 
the  vagina  by  means  of  the  astringent  lotion." 


DISEASES  NOT  REFERRED  TO  BY  CLASS. 

SCORBUTUS. 

Scurry. — The  blood,  in  this  disease,  is  generally  viti- 
ated and  in  a  depraved  condition,  the  system  most  gene- 
rally debilitated,  and  a  constant  tendency  to  haemorrhage, 
attended  with  more  or  less  inflammation  in  various  parts 
of  the  system,  but  especially  in  the  gums.  "  There  can 
scarcely  be  a  doubt  that  its  essential  character  is  an 
altered  state  of  the  blood,  and  that  all  its  phenomena 
flow  directly  or  indirectly  from  that  source.  In  this 
country  it  is  very  little  known,  and  there  are  many 
practitioners  even  in  our  cities  who  have  never  seen  a 
decided  case  of  it.  But,  as  its  prevalence  depends  on 
causes  which  may  be  brought  into  operation  at  any 
time,  and  in  any  place,  it  becomes  important  that  the 
.  profession  should  be  thoroughly  conversant  with  all  that 
relates  to  it,  so  that  it  may  be  at  once  encountered  when 
met  with,  and  means  of  prevention  suggested  wherever  * 
they  may  seem  to  be  required.  This  remark  is  espe- 
cially applicable  to  the  regulation  of  the  diet  in  prisons, 
hospitals,  asylums,  garrisons,  ships,  &c,  which  frequently 
come  under  the  direction  of  the  medical  man,  and  should 


664 


SCURVY. 


always  have  reference  to  the  possible  occurrence  of  the 
disease  in  such  situations.  Even  the  regimen  of  the 
sick,  in  ordinary  private  practice,"  should  be  regulated 
by  the  physician  with  some  regard  to  scurvy,  which, 
within  the  experience  of  the  author,  has  appeared  to 
result,  in  one  instance  at  least,  from  a  restricted  diet, 
too  long  continued,  under  a  medical  direction. 

The  definition  given  by  Dr.  Good,  is  short  but  perfect, 
he  says,  spots  of  different  hues,  intermixed  with  livid, 
principally  at  the  roots  of  the  hair,  teeth  loose,  gums 
spongy  and  bleeding,  breath  fetid,  debility  universal  and 
extreme :  and,  he  adds,  occurs  chiefly  at  sea,  after  ex- 
posure to  a  moist,  cold,  and  foul  atmosphere,  with  long 
use  of  salted  food  and  stagnant  water.  It  is  not  con- 
fined to  mariners,  for  numerous  and  well  marked  cases 
have  occurred  and  prevailed  extensively  in  large  inland 
institutions. 

Causes. — A  very  distinguished  author  says,  it  is  occa- 
sioned by  cold,  moist  air,  by  the  constant  use  of  salted 
or  smoke-dried  provisions,  or  any  kind  of  food  that  is 
hard  of  digestion  and  affords  little  nourishment;  it  may 
also  proceed  from  the  suppression  of  customary  evacua- 
tions, as  the  menses,  bleeding  piles,  &c,  neglect  of  clean- 
liness, bad  clothing,  want  of  proper  exercise,  confined 
air,  unwholesome  food,  or  any  disease  that  generally 
weakens  the  body  or  vitiates  the  humors,  may  cause  it. 

Symptoms. — The  disease  makes  its  appearance  very 
gradual,  accompanied  with  unusual  weariness,  and  diffi- 
*  culty  of  breathing  upon  the  least  exertion,  the  gums 
bleed,  and  they  are  generally  soft,  spongy,  and  present 
a  livid  appearance,  there  is  frequent  haemorrhage  from 
the  nose,  and  the  face  assumes  a  yellowish  hue  or  lead 
color,  the  breath  is  fetid  and  very  disagreeable.    "  If 


SCURVY. 


665 


attention  be  paid  to  the  skin,  it  will  generally  be  found 
covered  with  livid  spots,  which  run  together,  especially 
about  the  thighs  and  legs.  The  legs  sometimes  present 
a  dropsical  appearance,  and  again  the  muscles  on  them 
seem  to  be  wasting  away,  there  is  generally  a  bloody 
secretion  which  exudes  from  the  sores,  and  throughout 
the  whole  course  of  the  disease  there  is  excessive  pain 
experienced  in  the  limbs;  at  the  close  you  have  hectic 
fever,  and  the  patient  is  apt  to  be  carried  off  with  dys- 
entery, diarrhoea,  dropsy,  or  inflammation. 

"  Scurvy  is  occasionally  complicated  with  other  dis- 
eases, which  greatly  aggravate  the  danger.  Of  these, 
the  most  fatal  are  typhus  fever  and  dysentery,  which 
are  the  most  common  attendants,  as  they  are  produced 
by  causes,  which,  if  not  identical,  are  very  frequently 
coincident  with  those  of  the  complaint  under  examina- 
tion." 

Treatment. — There  is  probably  no  disease  that  yields 
more  readily  to  proper  treatment  than  scurvy,  and  I 
as  well  as  many  others  regard  the  treatment  as  sim- 
ple. Your  first  object  will  be  to  remove  the  patient 
from  under  the  influence  which  caused  the  disease,  and 
give  suitable  food,  especially  fresh  vegetables  and  vege- 
table acids ;  if  he  has  been  breathing  a  foul  atmosphere 
have  him  removed  to  where  there  is  a  pure  one;  in  its 
incipient  stages,  milk,  fresh  bread,  and  cider  will  gene- 
rally give  relief.  Some  advise  with  the  patient's  food, 
cream  of  tartar  and  muriatic  acid,  this  latter  remedy 
will,  I  have  no  doubt,  used  once  in  a  wrhile,  prevent  the 
disease,  and  may  probably  benefit  it.  Lemon  juice  is 
of  itself  an  excellent  remedy  for  scurvy,  it  can  be  used 
in  the  form  of  lemonade. 

Dr.  G.  Perm,  of  the  army,  found  the  juice  of  agave 


666 


SCURVY. 


Americana,  the  maguey  of  the  Mexicans,  in  the  dose  of 
two  to  three  fluid  ounces,  three  times  a  day,  a  more 
efficacious  remedy  than  lime  juice. 

You  will  find  a  decoction  or  syrup  of  the  yelloio  dock, 
in  doses  from  one  ounce  to  three,  taken  three  or  four 
times  a  day,  an  eminently  useful  article  in  scorbutic 
diseases. 

In  regard  to  the  medicinal  treatment,  if  there  is  con- 
stipation, correct  it  by  laxatives,  such  as  rhubarb  and 
castor  oil.  If  the  appetite  is  feeble,  it  may  be  stimu- 
lated, in  some  instances,  by  tonic  bitters  and  mineral 
acids.  The  astringents  may  sometimes  be  found  useful 
in  checking  haemorrhage.  In  obstinate  wakefulness, 
give  opium.  Nitre,  or  a  solution  of  this  salt  in  vinegar, 
has  anti-scorbutic  virtues.  Under  no  circumstances  ad- 
minister mercury  in  tins  disease.. 

Wherever  there  is  debility,  and  a  tonic  is  indicated,  I 
would  advise  the  following  to  be  given,  viz  : — 

I^.    Iodide  of  iron,  grs.  xxiv. 

Distilled  water,  fl.  Si. 

Mix.    Dose,  a  tea-spoonful,  three  times  a  day. 
The  following  recipe  has  been  adopted  in  hospital 
practice ;  it  has  been  attended  with  decided  advantage. 

fy.    Potass,  nitrat.,  (nitre,)  gii. 

  bitartrat,,  (cream  tartar,)  Sss. 

Aceti, 

Tinct.  opii,  fl. 
Aqua?,  (water,)  fl.  Siv. 

Dose,  two  table-spoonsful,  to  be  given  three  times  a 
day. 

As  to  local  remedies,  solution  of  chloride  of  lime, 


SCURVY. 


667 


very  dilute  muriatic  acid,  or  metallic  astringent  solu- 
tions, as  those  of  sulphate  of  zinc,  sulphate  of  copper, 
nitrate  of  silver,  or  acetate  of  lead,  may  be  applied  to 
the  gums;  and  a  mouth-wash  of  solution  of  kreosote 
may  be  used  to  correct  the  fetor  of  the  gangrenous 
ulcers.  For  ulcers  upon  the  surface,  the  best  applica- 
tion is  said  to  be  dressings  of  lint,  soaked  in  a  mixture 
of  one  part  of  lemon-juice  "and  two  or  three  parts  of 
water,  with  a  covering  of  oiled  silk,  to  prevent  evapo- 
ration. The  tincture  of  myrrh  is  also  a  good  applica- 
tion. If  there  is  pain,  relief  will  be  obtained  from 
anodyne  and  emollient  cataplasms  or  fomentations. 

Since  I  have  commenced  the  publication  of  this  work, 
"  numerous  experiments  have  been  made,  with  a  view 
of  determining  the  condition  of  the  blood  in  scurvy. 
It  has  frequently  been  found  to  coagulate,  and  even  to 
present  the  cupped  surface.  From  a  comparison  of 
those  most  to  be  relied  on,  it  appears  that,  upon  an 
average,  the  proportion  of  albumen  is  about  as  in  health, 
that  of  fibrin  slightly  increased,  and  that  of  the  red 
corpuscles  greatly  diminished.  The  saline  constituents 
are  in  about  the  normal  quantity.  The  microscopic 
characters  of  the  red  corpuscles,  and  their  chemical  con- 
stitution so  far  as  discovered,  do  not  appear  to  be  altered. 
MM.  Chatin  and  Bouvier  noticed  that  the  albumen,  in 
a  case  which  they  examined,  required  a  temperature  for 
coagulation  of  165°  F.,  at  least  5°  higher  than  is  requi- 
site in  health,  and  that  the  plasticity  or  cohesion  of  the 
fibrin  was  greatly  diminished. 

"  Some  interesting  experiments  have  been  made  by 
Dr.  Garrod,  of  London,  which  direct  attention  to  potassa 
as  the  ingredient  of  the  blood,  a  deficiency  of  which 
may  be  the  characteristic  pathological  condition  of 


668 


TUMORS. 


scurvy.  Dr.  Garrod  found  1st,  that  articles  of  food,  the 
exclusive  use  of  which  were  known  to  produce  scurvy, 
contained  less  of  the  salts  of  potassa,  than  those  which 
are  capable  of  supporting  the  system  in  the  healthy  state ; 
2nd,  that  those  substances  which  act  as  anti-scorbutics, 
such  as  fresh  fruits  and  vegetables,  and  especially  pota- 
toes, contain  a  large  proportion  of  these  salts ;  3rd,  that 
the  blood  of  a  scorbutic  patient,  examined  by  himself, 
contained  a  much  smaller  proportion  of  potassa  than 
healthy  blood,  and  that  less  was  excreted  with  the 
urine ;  and  4th,  that  the  disease  may  be  cured  by  the 
addition  of  small  quantities  of  some  one  of  the  salts  of 
potassa  to  the  food.  Dr.  Garrod  also  makes  the  sug- 
gestion, that  the  muscular  debility  of  scurvy  may  be 
explained  upon  the  supposition,  that  the  muscles  are 
deficient  in  potassa,  which  is  contained  in  them  largely 
in  health,  and,  according  to  Liebig,  is  essential  to  their 
action."  But  it  appears  to  me  that  much  further  inves- 
tigation will  be  necessary  before  the  truth  of  this 
hypothesis  can  be  considered  as  established.  Opposed 
to  it  at  present  are  the  facts,  that  nitre,  which  is  a  salt 
of  potassa,  though  said  to  be  occasionally  useful  in 
scurvy,  has  often  failed  to  cure  it ;  that,  on  the  contrary, 
the  disease  has  been  cured  simply  by  the  addition  of 
pure  citric  acid,  which  contains  no  potassa,  to  the  diet 
of  the  patient ;  and  that  nitre  is  frequently  used  in  the 
preparation  of  salted  beef,  which  is  one  of  the  promi- 
nent substances  used  as  food  by  scorbutic  crews. 

TUMOKS. 

There  is  such  a  variety  of  tumors  that  it  would  be 
difficult,  in  a  work  of  this  character,  to  give  a  precise 
description  of  each;  suffice  to  say  that  we  have  the 


TUMORS. 


G69 


adipose  tumors,  which  are  generally  styled  fatty  tumors. 
The  fibrous  tumor ;  it  has  somewhat  the  appearance  of 
the  adipose  tumor;  it  is  composed,  apparently,  as  the 
name  implies,  of  a  fibrinous  substance,  and  when  divi- 
ded presents  you  a  yellow  or  whitish  substance.  Cellular 
tumors  differ  from  the  two  first,  from  the  fact  that  they 
contain  oily  or  sebaceous  matter.  Malignant  tumors. — 
Any  of  the  variety  of  tumors  may  become  malignant, 
but  this  variety  is  generally  known  as  cancer. 

Treatment. — In  the  treatment  of  these  cases  you  may 
sometimes  succeed  by  promoting  absorption  by  the 
application  of  strong  stimulants,  with  compression  con- 
stantly applied.  If  the  ordinary  stimulants  fail,  accom- 
pany the  compression  with  means  to  excite  slow  but 
long  continued  inflammation  of  the  surface.  The  irri- 
tation, kept  on  with  compression  for  a  long  time,  has 
often  succeeded,  especially  when  associated  with  the 
proper  internal  means  for  aiding  absorption,  such  as 
diaphoretics,  and  still  more,  diuretics  and  hydragogue 
cathartics.  The  hydriodate  of  potash,  and  other  prepa- 
rations of  iodine,  have  been  highly  recommended  by 
many ;  but  though  I  have  seen  successful  results  from 
their  application,  so  far  as  the  local  absorption  is  con- 
cerned, the  deleterious  effects  on  the  constitution  gene- 
rally, and  the  proneness  of  tumors  so  removed  to  return, 
induce  me  to  have  an  equivocal  regard  for  the  remedies. 

If,  then,  after  a  fair  trial  of  the  local  and  general 
means  pointed  out,  you  fail,  as  you  may  expect  to  do  in 
many  instances,  and  the  tumor  is  so  situated  as  to  be 
conveniently  operated  upon,  the  knife  is  generally  the 
best  means  you  can  resort  to. 

Tumors  can,  however,  in  some  cases,  be  removed  by 
the  ligature  or  caustic  potash.    Dr.  Beach  says  the  fol- 


670 


TUMORS. 


lowing  is  the  best  mode  of  applying  it :  Take  a  stick  or 
roll  of  the  caustic  potash,  and  enclose  it  in  a  piece  of 
paper,  all  except  the  end,  to  prevent  injury  to  the  fin- 
gers ;  then,  after  wetting  the  most  prominent  part  of 
the  tumor,  gently  touch  or  rub  it  in  a  circular  form 
about  the  size  of  a  twenty-five  cent  piece,  or  according 
to  the  size  of  the  tumor,  to  be  continued  until  the  skin 
turns  brown  or  dark,  which  is  usually  in  about  five  or 
ten  minutes.  As  the  caustic  dissolves  it  runs  down  and 
excoriates  the  parts ;  this  should  be  absorbed  by  cotton 
or  linen.  The  pain  is  severe  for  a  short  time,  and  no 
more  is  experienced  until  the  eschar  separates.  A  poul- 
tice of  elm  bark  and  yeast  must  now  be  kept  on,  to 
favor  the  process  of  sloughing,  or  a  detachment  of  the 
disorganized  parts,  which,  when  done,  gives  vent  to  the 
internal  portion  or  substance  of  the  tumor. 

The  marshmallow,  externally  applied  in  the  form  of 
poultice,  is  very  useful  to  discuss  painful  inflammatory 
tumors  and  swellings  of  almost  every  kind. 

Beach  speaks  highly  of  the  poke  root  roasted  and 
afterwards  mashed,  as  an  application  to  tumors. 

Females. — Their  breasts  frequently  become  inflammed 
and  indurated.  I  have  seen  relief  from  the  application 
of  either  of  the  following  remedies,  viz. :  Parsley  leaves, 
bruised,  are  a  valuable  application ;  in  some  instances, 
however,  they  have  a  tendency  to  dry  up  the  milk. 
The  celastrus  scanclens,  (staff  vine  or  false  bitter  sweet,) 
has  been  successfully  employed  in  inflamed  and  indu- 
rated breasts.  As  a  local  application  to  all  species  of 
painful  tumors,  especially  swelled  breasts,  the  datura 
stramonium,  or  Jamestown  weed  will  be  found  a  most 
soothing  application. 

The  pearl  flowered  life  everlasting,  used  externally  as 


SPRAINS. 


G71 


a  cataplasm  in  painful  tumors,  is  very  efficacious  in 
relieving  pain  and  disposing  to  sleep,  often  succeeding 
when  the  hop  poultice  has  proved  ineffectual. 

SPRAINS. 

Sprain. — By  this  term  we  understand  an  injury  or 
contusion  of  some  part  of  the  body,  without  laceration 
or  breaking  of  the  skin.  A  bruise  is  often  very  painful, 
soon  swells,  and  turns  the  skin  black  or  purple. 

Treatment. — The  best  application  is  wormwood  leaves, 
simmered  in  vinegar  to  extract  the  strength,  with  a  lit- 
tle salt  added,  to  be  applied  cold  or  warm,  as  agrees 
best ;  nothing  so  soon  reduces  the  swelling.  Cold  water 
applications,  with  a  bandage,  will  be  found  very  effective 
in  keeping  down  inflammation.  The  last  application 
suggested  in  tumors  will  be  found  efficacious.  Salt  and 
tallow  mixed  will  prevent  the  skin  from  turning  black. 

If  inflammation  should  present  itself,  you  will  resort 
to  the  same  means  as  are  required  to  subdue  acute 
inflammation.  If  the  joint  is  involved  in  the  injury, 
suppuration  about  it  must  be  prevented  if  possible; 
hence  emollient  applications  are  not  indicated.  Resolu- 
tion is  here  the  only  safe  termination  of  inflammation. 
If  you  would  therefore  escape  ulceration  and  destruction 
of  the  joint,  do  not  allow  the  lately  injured  joint  to  be 
moved  for  some  time. 

Strains  of  the  wrist,  produced  by  falls  or  other  vio- 
lence, may  occasionally  similate  dislocation.  They  may 
be  distinguished  by  the  fact  of  the  questionable  symp- 
toms coming  on  gradually,  and  not  showing  themselves 
immediately  after  the  accident,  as  in  actual  dislocation. 
There  will  also  be  more  flexibility  of  the  hand ;  nor  will 


672 


SPRAINS. 


the  swellings  be  likely  to  imitate  accurately  the  separa- 
ted extremities  of  the  arm  and  carpal  bones. 

As  soon  as  the  reduction  is  effected,  compresses 
should  be  placed  upon  the  wrist,  and  secured  by  a  roller, 
the  part  being  kept  constantly  wet  with  cold  water  or 
spirits  and  water.  The  roller  should  enclose  the  whole 
hard,  commencing  from  the  end  of  the  fingers,  and  be 
continued,  moderately  tight,  up  to  the  elbow.  A  splint 
should  afterwards  be  added,  and  the  forearm  suspended 
in  a  sling. 

These  accidents  are  very  painful,  and  liable  to  much 
swelling,  if  means  are  not  instituted  to  prevent  it ;  but 
uniform  and  pretty  tight  bandaging,  will  generally  do 
this,  if  applied  early  in  connection  with  the  cold  water. 
If  the  parts  become  very  painful,  they  should  be 
fomented  with  warm  water  or  vinegar,  or  hops  and 
vinegar.  Salt  and  vinegar  is  a  good  application  to  pre- 
vent inflammation. 

ULCERS. 

There  are  many  different  kinds  of  ulcers,  and  in  all 
warm  climates  they  are  quite  common,  and  none  more 
common  than  "  old  sore  legs."    There  is  an  excess  of 
this  class  over  any  other  variety.    A  work  has  been 
compiled  by  Dr.  Newton,  of  Cincinnati,  upon  this  class 
of  diseases,  and  I  refer  the  reader  to  it,  as  much  valu- 
able information  can  be  gleaned  therefrom.    I  have  had 
much  experience  in  the  treatment  of  ulcers,  much  of 
my  success  in  their  treatment,  I  attribute  to  the  sugges- 
tions I  received  from  an  eclectic  author  of  distinction, 
from  whom  I  shall  quote  very  .  extensively  upon  this 
subject.    The  division  of  the  subject  in  many  instances, 
is  not  necessary  for  practical  purposes ;  however,  they 


ULCERS. 


G73 


are  generally  divided  by  writers,  into  a  variety  of  classes, 
according  to  their  appearance,  progress  and  effects.  I 
have  adopted  Hill,  it  will  be  sufficient  for  all  practical 
purposes,  though  as  he  says,  not  so  minute  as  may  be 
found  in  some  of  the  books. 

I  would  have  you  distinguish  the  healthy  ulcer ;  the 
irritable,  the  indolent,  the  varicose  and  specific,  this 
last,  however,  includes  a  variety  which  I  have  already 
considered ;  as  examples,  I  may  here  mention  scrofu- 
lous, sj'philitic,  &c. 

Healthy  ulcer. — It  is  a  suppurative,  but  not  an 
ulcerating,  i.  e.  destructive  process.  The  pus  discharged 
by  it  is  a  normal  secretion.  Its  surface  has  a  florid 
appearance,  without  any  offensive  smell.  The  pus  is 
consistent,  and  easily  removed.  The  granulations  are 
small,  and  of  a  uniform  size.  It  heals  spontaneously 
and  regularly,  leaving  little  or  no  trace  of  having 
existed.  Patches  of  granulations  may  be  early  noticed, 
over  the  top  of  which  is  thrown  a  delicate  membrane 
or  cuticle,  which  finally  thickens  and  becomes  true  skin. 

An  example  of  the  healthy  ulcer  is  the  common  boil, 
which,  if  not  an  evidence  of  perfect  health,  is  regarded, 
and  no  doubt  correctly,  as  the  next  thing  to  it ;  a  suc- 
cessful effort  to  throw  off  some  slight  obstruction  or 
impurity.  It  may  appear  on  any  part  of  the  body,  and 
occasions  no  difficulty  further  than  the  local  pain  and 
temporary  inconvenience. 

Treatment. — This  character  of  ulcer  requires  but  little 
treatment,  the  "  let  well  enough  alone  practice  ;  a  little 
salve  to  protect  it  from  the  atmosphere,"  is  generally  all 
sufficient.  The  only  ^§ue  healing  salve,  is  that  which 
nature  prepares  for  herself — healthy  pus.  Now  this, 
however,  when  produced  in  large  quantities,  may  be 
43 


674 


ULCERS. 


injurious  to  the  general  health,  by  being  reabsorbed.  In 
that  case,  it  should  be  frequently  removed,  or  the  ulcer 
dressed  with  some  substance  that  will  absorb  it.  The 
carrot  poultice  answers  this  purpose  very  well,  as  it  re- 
moves the  matter  without  irritating  the  sore.  The 
simple  water  dressings  are,  perhaps,  after  all,  the  best 
that  can  be  "  invented they  may  be  warm  or  cool, 
rarely  cold.  If  there  should  be  want  of  action  in  the 
ulcer,  the  application  of  the  tincture  of  gum  myrrh  or 
tincture  of  iodine  will  be  found  most  excellent. 

Irritable  Ulcer. — This  variety  is  very  sore  to  the 
touch,  and  easily  made  to  bleed.  It  generally  wears  a 
dark  purplish  appearance,  discharging  but  little  matter, 
and  that  of  a  thin,  ichorous  or  sanious  appearance,  and 
sometimes  very  foetid  and  corroding.  Its  imperfect 
granulations  are  spongy,  of  a  dark  red  hue,  or  having  a 
whitish  vesicular  look,  appearing  at  different  points,  or 
leaving  vacant  spaces  between  them,  and  often  disappear- 
ing again  by  absorption.  It  is  bounded  by  a  sharp  under- 
mined (or  shelving)  edge,  sometimes  rugged,  nearly 
what  would  be  called  in  botany,  "  serrated."  The  parts 
around  the  ulcer  are  swollen  and  reddened,  sometimes 
cedematous,  (swelled). 

The  constitutional  effects  of  this  kind  of  ulcer  are 
often  very  great,  and  manifested  by  thirst,  chills,  and 
great  nervous  prostration,  as  well  as  irritability.  The 
pain  at  the  part  affected,  which  is  often  great,  is  of  a 
smarting  or  burning  character.  The  worst  result  is, 
when  the  irritable  ulcer  becomes  gangrenous. 

Treatment. — This  should  be  the  most  soothing  and 
emolient  possible ;  warm  poultices  will  sometimes  be 
sufficient.  Fomentations  of  bitter  herbs  are  often  re- 
quired, those  of  hops  or  poppy  leaves  are  particularly 


ULCERS. 


675 


suitable.  They  should  be  repeated  two  or  three  times 
a  day,  the  ulcer  being,  between  times,  dressed  with  the 
emollient  poultices.  One  of  the  best  of  these  is  made 
of  the  roots  of  the  common  carrot,  bruised  and  roasted, 
or  still  better,  grated  and  wet  in  scalding  water,  and 
then  allowed  to  cool.  If  these  means  are  insufficient, 
lint  dipped  in  laudanum,  may  be  added.  A  poultice 
wet  with  a  strong  infusion  of  lobelia  herb,  or  the  ex- 
pressed juice,  will  frequently  relieve  when  other  means 
fail.  These,  or  some  such  applications  as  these,  should 
be  continued  till  the  soreness  and  inflammatory  symp- 
toms have  subsided.  Be  sure  when  dressing,  never  to 
compress  this  kind  of  ulcer,  so  long  as  it  retains  its 
character  of  irritable. 

In  some  instances,  after  a  long  continuance  of  moist 
applications,  they  seem  to  lose  their  power,  and  the  irri- 
tability returns.  They  should  then  be  changed  for  dry. 
Simple  flour  will  sometimes  answer,  or  prepared  chalk, 
finely  pulverized.  But  the  best  dry  dressing  is  the  pow- 
der of  the  common  puff  ball,  (lycopherdon  borista.)  Dry 
applications  may  likewise  fail,  and  it  may  become  neces- 
sary to  return  to  your  liquids,  which  may  then  succeed. 

When  the  irritable  ulcer  presents  a  gangrenous  ap- 
pearance, or  where  mortification  really  exists,  it  will 
then  require  an  active  and  speedy  treatment.  The  pro- 
fession, as  well  as  the  public  are  acquainted  with  the 
remedies  generally  used  for  mortification.  Dr.  Newton 
has  discovered  in  the  sulphate  of  zinc,  (white  vitriol) 
anti-septic  properties,  and  has  employed  it  with  such 
success,  that  it  becomes  a  matter  of  much  interest  to  the 
profession.  He  says  it  is  sufficient  to  fulfil  every  indi- 
cation, and  full  reliance  and  confidence  may  be  placed 
upon  it.    He  says  : 


676 


ULCERS. 


"  This  agent  may  also  be  used  in  the  treatment  of  some 
varieties  of  erysipelas,  which  will  be  referred  to  here- 
after. Sulphate  of  zinc  is  the  article  to  which  I  wish 
to  draw  the  attention  of  practitioners,  as  a  remedy  for 
mortification,  and  to  show  its  beneficial  results,  by  the 
description  of  a  few  cases  treated  by  it.  It  may  be 
argued  that  the  use  of  any  remedy  that  will  of  itself  pro- 
duce active  inflammation,  could  not  be  applied  to  a 
highly  inflamed  part,  without  producing  fatal  conse- 
quences, by  increasing  the  disease  beyond  the  reach  of 
remedies.  This  will  doubtless  appear  true  to  many,  but 
experience  has  proved  to  the  contrary,  for  it  has  been 
used  in  cases  where  the  parts  were  in  the  highest  state 
of  inflammation,  and  although  this  was  increased  for  a 
few  hours  by  its  action,  yet  in  no  case  have  I  found  it 
to  produce  any  bad  effect,  or  to  so  augment  this  condi- 
tion, as  to  present  any  difficulty  in  the  subsequent  treat- 
ment. It  will  be  remembered  that  all  cases  of  mortifi- 
cation are  attended  with  a  very  offensive  fetor,  which  is 
one  of  the  characteristic  symptoms  of  this  disease,  and 
which  is  caused  by  a  decomposition  of  the  healthy  struc- 
ture of  the  parts  attacked,  and  this  very  cause  produces 
the  continuance  of  the  disease,  the  changing  of  which  is 
the  indication  to  be  fulfilled  by  every  variety  of  treat- 
ment that  has  been  adopted. 

No  agent  will  act  so  immediately  in  producing  this 
change  as  the  sulphate  of  zinc;  the  most  extensively 
mortified  surface,  with  the  offensive  fetor  arising  from 
it,  can  be  stopped  in  a  few  hours  after  its  application, 
and  after  one  or  two  applications  the  parts  become  hard- 
ened, and  the  fetor  entirely  removed.  It  fulfils  two 
indications  in  this  respect,  viz :  arresting  the  decompo- 


ULCERS. 


677 


sit  ion  going  on  in  the  parts,  and  correcting  all  unplea- 
sant fetor  which  may  exist ;  and  it  should  be  borne  in 
mind,  that  as  long  as  this  fetor  is  present,  the  disease  is 
not  arrested.  The  following  cases  will  be  illustrative  of 
the  method  of  using  it,  in  which  I  have  found  it  useful. 

Case  I. — Mr.  F.,  aged  25,  residing  in  Fulton,  came  to 
consult  me  in  December,  1846,  with  an  extensive  morti- 
fication of  the  whole  palatine  arch  and  gums  of  the  supe- 
rior maxillary,  succeeding  a  mercurial  action  which  had 
been  produced  and  continued  a  long  time,  and  which 
had  resisted  the  usual  treatment  for  its  arrest.  I  was 
induced  to  try  the  sulphate  of  zinc,  and  mixed  a  small 
quantity  of  it  in  fine  powder,  with  a  sufficient  quantity 
of  flour  and  water  to  make  a  paste ;  this  I  spread  upon 
soft  leather  and  applied  over  the  parts  affected,  retain- 
ing it  there  until  the  paste  sufficiently  adhered,  by  a 
sponge  placed  upon  the  tongue.  I  would  here  remark, 
that  this  was  a  well  marked  case.  The  fetor  arising 
from  the  mouth  was  such  that  one  could  scarcely  stay 
in  the  room  with  him. 

On  the  succeeding  day  I  found  the  fetor  much  dimin- 
ished, and  the  parts  secreting  but  little,  with  a  portion 
entirely  hardened.  I  made  a  second  application  in  a 
similar  manner,  and  on  the  next  morning  the  unplea- 
sant fetor  was  entirely  removed,  and  the  whole  of  the 
diseased  parts  covered  with  a  dry,  hard  surface,  and  no 
vestige  of  secretion  from  any  part  of  it.  I  considered 
this  to  have  been  carried  far  enough,  and  made  no  further 
application  of  the  zinc,  but  recommended  the  mucilage 
of  ulmus  and  warm  water  to  be  used  freely  in  the  mouth, 
which  was  pursued  for  three  days,  when  the  entire  por- 
tion upon  which  the  zinc  had  been  used,  sloughed  off, 
leaving  a  health  appearance  of  the  parts.    It  may  be 


678 


ULCERS. 


well  to  state  here,  that  the  entire  structure  of  the  arch, 
with  a  large  portion  of  the  bone  came  away,  after  which  , 
it  was  treated  as  a  common  ulcer,  and  healed  in  about 
ten  days,  since  which  time  he  has  remained  in  good 
health. 

Case  II. — Mrs.  S.  was  under  treatment  for  a  cancer- 
ous condition  of  the  breast.  It  had  ulcerated,  and  was 
attended  with  all  the  unpleasant  symptoms  of  such  a 
condition.  I  made  use  of  caustic  applications  for  its 
removal,  but  found  upon  the  second  day,  that  the  whole 
gland  was  in  a  state  of  mortification,  and  that  the  sys- 
tem was  fast  failing  from  its  effects.  I  immediately 
applied  the  zinc,  in  the  form  of  powder,  covering  the 
affected  parts  with  it ;  in  less  than  six  hours  a  change 
of  the  fetid  smell  was  very  perceptible,  but  the  inflam- 
mation continued  without  any  abatement  during  twenty- 
four  hours.  On  the  next  day  I  found  the  remedy  had 
dried  and  hardened  a  portion  of  the  diseased  surface ;  I 
therefore  again  applied  it,  and  covered  the  medicine  with 
a  poultice  of  elm  bark,  mixed  with  cold  water ;  this  dis- 
solved the  zinc  in  a  few  hours,  and  had  the  desired  effect 
of  changing  and  arresting  any  further  extension  of  mor- 
tification. In  this  case  two  applications  were  sufficient. 
It  will  be  found  that  in  some  cases,  the  zinc  will  pro- 
duce a  hardened  surface,  so  as  to  prevent  a  sufficient 
quantity  from  acting  throughout  the  diseased  parts ;  this 
can  be  remedied  by  applying  an  elm  poultice  after  the 
zinc  is  used,  which  will  soften  the  surface  enough  to 
allow  its  full  action,  which  is  known,  as  before  said,  by 
absence  of  the  fetor.  All  the  dressing  that  is  required 
is  the  elm  poultice,  both  before  and  after  the  use  of  the 
zinc ;  if  the  first  application  increases  the  inflammation 
to  any  extent,  apply  the  elm  for  ten  or  fifteen  hours, 


ULCERS. 


679 


after  which  apply  the  zinc.  The  part  will  usually  slough 
off  in  three  or  four  days. 

Case  III. — J.  F.,  aged  4S,  had  an  encephaloid  tumor, 
situated  on  the  leg,  which  required  to  be  removed  by  an 
operation,  previous  to  the  application  of  medicine  for  its 
permanent  cure.  J.  King,  M.  D.,  assisted  me  in  remov- 
ing the  tumor,  which  had  arrived  at  several  inches  in 
diameter.  It  was  removed  without  any  unnatural  ap- 
pearances attending  the  case.  But  on  the  second  day, 
the  whole  incision,  and  for  three  inches  around,  became 
gangrenous,  and  accompanied  with  a  high  degree  of 
inflammation.  I  immediately  applied  the  zinc,  and  con- 
tinued it  for  three  days,  when  it  became  completely 
arrested,  and  in  three  days  longer  the  diseased  parts 
sloughed  off,  leaving  a  healthy  condition  of  the  remain- 
ing integuments,  which  were  then  treated  without  any 
further  difficulty. 

I  have  made  use  of  this  agent  in  forty-five  cases,  and 
in  each  it  proved  highly  successful,  so  much  so,  that  in 
only  five  cases  was  a  slight  constitutional  treatment 
demanded.  As  these  cases  are  all  similar  to  those  given, 
I  deem  it  unnecessary  to  particularize  any  further. 

In  four  cases  of  ulcerated  erysipelatous  inflammation, 
I  have  used  the  zinc  with  similar  success,  though  in 
these  instances  it  required  a  smaller  quantity  of  the  arti- 
cle, a  greater  number  of  applications,  and  at  greater 
intervals  between  the  applications.  At  some  future  time 
I  may  again  refer  to  this  article,  and  its  effects  in  other 
forms  of  disease." 

I  have  used  the  following  recipes  in  foul  and  gangre- 
nous ulcers,  with  advantage,  viz  : — Freshly  prepared 
charcoal,  sufficient ;  mix  with  simple  cataplasm,  in  a 
tepid  state ;  or, 


G80 


ULCERS. 


fy.    Powdered  charcoal,  Sss. 

Cataplasm  of  chamomile.    Use  as  above. 

But  constitutional  treatment  is,  after  all,  of  more  im- 
portance than  any  local  applications,  though  these  need 
never  be  omitted  on  that  account.  You  will  generally 
observe  the  patient's  skin  to  be  dry  and  harsh ;  he  is 
also  inclined  to  be  thirsty  and  feverish.  As  a  general 
rule,  the  irritable  ulcers  occur  in  irritable  subjects. 

There  is  a  plain  indication  then  for  the  alkaline  bath, 
which  should  be  used  at  least  twice  a  day,  in  connection, 
perhaps,  with  the  alcoholic  vapor.  An  emetic  slowly 
given,  our  common  emetic  tincture,  for  instance,  exerts 
a  very  marked  influence,  the  following  is  the  recipe,  viz : 

1$!.  Bloodroot. 
Lobelia  seeds. 

Skunk  cabbage  root,  aa.  Siss. 

Make  the  powders  moist  with  alcohol,  and  let  them 
stand  tightly  covered  for  twenty-four  hours,  then  add 
good  cider  vinegar  one  quart.  Mix,  and  let  it  digest 
two  weeks,  then  strain  and  press  the  dregs. 

Dose,  one  drachm,  repeated  at  short  intervals  until  it 
produces  the  desired  effect.  This  should  be  followed  up 
with  mild  cathartics.  Diaphoretics  and  sudoriflcs  must 
not  be  neglected.  Such  as  asclepias  tuberosa,  (pleurisy 
root,)  gerardia  pedicularia,  (American  fox  glove,)  xan- 
thoxylum  fraxineum,  (prickly  ash.)  I  have  commonly 
prescribed  an  infusion  of  the  pleurisy  root,  prickly  ash, 
and  skunk's  cabbage,  as  a  preparation  both  sudorific  and 
anodyne. 

If  the  gentler  means  fail,  you  must  not  stop  here,  but 
bring  out  free  perspiration  by  means  of  the  "  alcoholic 
sweat,"  and  keep  it  up  for  at  least  an  hour,  or  until  the 
irritable  condition  has  been  removed. 


ULCERS. 


681 


As  soon  as  this  is  effected,  and  the  pain  ceases  in  the 
ulcer,  the  former  dressings  may  be  removed.  You  pro- 
ceed as  in  the  case  of  a  "  simple  ulcer,"  guarding  against 
relapse,  however,  by  appropriate  constitutional  means, 
such  as  the  alterative  syrup,  which  is  as  follows,  viz : 
I$5.    Sarsaparilla,  3  lbs. 

Burdock. 
Sassafras. 

Guaiac,  aa.  2  lbs. 

Spikenard. 

Prickly  ash. 

Ex.  Liquorice,  aa.  i  lb. 

Ex.  Juglans,  (butter-nut,)  §i. 

Essence  of  sassafras,  Bii. 
Make  four  gallons  of  syrup.  Dose,  one  to  three  tea- 
spoonsful  four  times  a  day,  before  each  meal  and  bed 
time,  with  gentle  aperients  and  diaphoretics,  and  a  per- 
severing use  of  the  alkaline  bathing  or  sponging.  As  a 
simple  alterative  in  these  cases,  the  icoodbine  is  one  of 
the  best  in  the  materia  meclica.  It  should  always  be 
used  green,  as  it  loses  its  virtues  in  drying.  This  may 
be  compounded  with  the  scrofularia  marylandrica,  (fig- 
wort,)  or  viburnum  prunifolium,  (black  haw,)  or  with 
both. 

Where  the  patient  is  naturally  of  a  nervous  temper- 
ament, and  there  has  been  considerable  nervous  derange- 
ment,! consider  the  common  motherwort  almost  a  specific, 
especially  if  he  has  been  a  hard  drinker.  (I  have  seen 
cases  of  delirium  tremens  cured  with  it.)  You  can 
administer  it  in  the  form  of  a  strong  syrup  of  the  leaves. 
I  prefer  equal  parts  of  the  root  and  leaves,  as  the  former 
is  strongly  diuretic. 

Indolent  ulcer. — This  is  almost  in  every  particular  the 


682 


ULCERS. 


opposite  of  the  irritable  ulcer ;  each  can  be  best  studied 
in  contrast  with  the  other.  Keverse  the  definition  of 
the  one  and  you  have  that  of  the  other.  The  edges  of 
the  sore,  for  instance,  are  more  erected  instead  of  being 
inverted,  as  in  the  former  case,  being,  moreover,  rounded 
and  thick,  somewhat  glossy  and  quite  regular.  The 
granulations,  instead  of  being  red  and  sensitive,  are  in- 
sensible and  of  a  dull  pale  aspect,  with  round  flat  heads, 
and  generally  located  on  the  bottom  of  the  excavation, 
they  have,  in  short,  a  fungoid  character.  The  pus, 
instead  of  being  ichorous,  (a  thin  aqueous  and  acrid 
discharge,)  is  thick,  of  a  dark  yellow  color,  and  so  firmly 
adherent  to  the  base  of  the  ulcer  that  it  cannot  be  re- 
moved without  considerable  force,  and  causing  a  good 
deal  of  pain,  (which,  of  course,  should  not  be  done.) 

This  kind  of  ulcer  is  the  more  important,  inasmuch 
as  it  is  the  most  common  form  of  sore  which  you  will 
be  called  upon  to  treat  professionally.  They  most  fre- 
quently occur  on  the  lower  extremities,  and  much  oftener 
in  males  than  females,  (the  latter  seldom  being  troubled 
with  them,  unless  in  connection  with  a  varicose  condi- 
tion of  the  limb.) 

Treatment. — The  treatment  of  this  ulcer,  like  its 
symptoms,  is  the  very  opposite  of  that  of  the  irritable 
ulcer.  Let  your  measures  be  of  the  most  stimulating 
kind.  The  first  indication,  is  to  change  the  character 
of  the  sore  from  sluggishness  to  healthful  activity — to 
excite  the  natural  restorative  action  of  the  vessels. 

If  the  parts  around  the  ulcer  be  very  hard,  it  may  be 
well  to  scarify,  and  apply  a  strong  stimulating  liniment. 
Hot  fomentations  will  aid  you  very  much  in  this  soften- 
ing process.  This,  with  perhaps  a  re-application  of 
your  caustic  once  or  twice  a  day,  will  generally  effect 


ULCERS. 


683 


such  a  change,  that,  in  the  course  of  a  few  days,  the 
sore  will  assume  a  healthy  aspect  and  begin  to  heal. 
Compresses  and  bandages  should  be  applied ;  the  com- 
presses should  be  wet  with  the  tincture  of  gum  myrrh, 
or  tincture  iodine,  twice  a  day,  and  if  persevered  in, 
this  of  itself  generally  will  effect  a  cure. 

If  you  carry  your  stimulating  treatment  so  far  as  to 
change  your  sore  into  an  irritable  instead  of  a  healthy 
ulcer,  the  usual  emollient  treatment  will  soon  bring  it 
down  to  the  healthy  standard.  All  that  is  then  re- 
quired, some  simple  dressing ;  the  common  black  salve 
answers  every  purpose ;  make  as  follows  : — 

]$5.    Olive  oil,  3  qts. 

Rosin, 

Beeswax,  aa.  Siii. 

Melt  the  articles  together,  and  raise  the  heat  as  high 
as  possible,  without  burning,  then  gradually  add  2i 
pounds  of  red  lead,  finely  pulverized;  stir  it  briskly, 
until  the  whole  mass  assumes  a  shining  dark  brown  or 
black  color.  Then  remove  it  from  the  fire,  and  con- 
tinue to  stir  until  it  is  nearly  cold.  When  about  blood 
warm,  add  pulverized  camphor  and  oil  of  sassafras  each 
one  ounce. 

Dr.  Beach  says  he  has  used  the  following  ointment 
with  success  : — Take  sweet  clover  tops  and  stalks,  bur- 
dock leaves,  and  parsley,  a  handful  of  each;  boil  in 
water  until  you  get  the  strength ;  strain,  and  add  one 
pound  of  rosin  and  a  quarter  of  a  pound  of  fresh  butter; 
simmer  until  of  a  proper  consistence. 

When  the  discharge  is  very  offensive,  you  can  correct 
it  by  applying  pyroligneous  acid  for  a  day  or  two.  The 


684 


ULCERS. 


oil  of  amber  exerts  a  good  influence  in  bringing  indo- 
lent ulcers  to  a  healthy  condition. 

These  cases,  however,  after  assuming  a  promising 
appearance,  are  very  liable  to  relapse.  The  tinctures 
of  myrrh,  iodine,  or  bloodroot,  will  generally  suffice  for 
their  restoration.  If  the  milder  caustic  is  not  sufficient 
to  keep  down  the  fungous  growth,  resort  to  the  stronger. 
After  cauterizing,  it  will  be  better  for  a  day  or  two,  to 
use  only  emollients.  A  poultice  of  the  indigo  wreed 
may  be  mentioned  as  suitable. 

If  the  hardening  should  assume  a  scirrhous  character, 
a  favorable  effect  may  be  obtained  from  the  stramonium 
ointment,  (Jamestown  weed,)  or  an  extract  of  poke 
root.  The  oil  of  hemlock  has  been  highly  recom- 
mended, either  alone  or  combined  with  the  tincture  of 
sanguinaria,  (blood  root.)  To  make  it  still  stronger, 
you  may  add  cayenne  pepper.  These  articles  make  a. 
fine  lotion,  where  there  is  a  gangrenous  tendency. 

For  some  time  past,  I  have  been  in  the  habit,  after 
cleansing  indolent  ulcers  with  the  vegetable  caustic,  or 
other  alkaline  preparations,  .of  putting  over  them  the 
irritating  plaster,  (which  see.)  By  this  means  you  can 
keep  up  a  free  purulent  discharge  for  several  weeks, 
occasionally  repeating  the  alkaline  wash.  I  then  dress 
with  black  salve,  applying  slight  compression.  This 
simple  course  effects  a  perfect  cure,  without  any  other 
means  excepting  the  appropriate  constitutional  treat- 
ment. 

The  constitutional  treatment,  however, .  is  scarcely 
less  important,  than  in  the  case  of  irritable  ulcers.  The 
alkaline  bath  should  be  used  once,  if  not  twice  •  every 
day.  Administer  also  the  alterative  syrup  before  al- 
luded to,  with  any  other  medicine  the  peculiarities  of 


ULCERS. 


G85 


the  patient  may  indicate,  among  which  will  generally 
be  an  occasional  active  cathartic. 

Varicose  Ulcers  are  so  named  because  they  are  always 
connected  with  a  swollen  or  varicose  condition  of  the 
neighboring  veins.  In  other  respects  they  may  present 
the  characteristics  of  either  of  the  other  two  contrasted 
classes.  May  be  either  indolent  or  irritable.  They  are, 
however,  almost  always  extremely  tender  to  the  touch, 
and  often  very  painful  when  the  part  is  exercised.  The 
pain,  indeed,  is  occasionally  excessive,  and  the  nervous 
system,  may  become  involved,  even  to  the  extent  of  deli- 
rium. 

Varicose  ulcers  seldom  occur  any  where  but  on  the 
lower  extremities,  and  then  only  below  the  knee.  Nearly 
all  the  small  veins  adjacent  to  the  ulcer  are  involved. 
The  reddish  brown  color  of  the  sore  extends  to  some 
distance  around.  The  ulcer  itself  may  be  superficial  or 
deep  and  burning. 

If  a  varicose  ulcer  presents  the  characteristics  of  the 
irritable,  the  first  measure  of  treatment  is  to  allay  the 
irritability,  by  some  of  the  means  before  directed.  If, 
as  is  more  common,  it  belongs  to  the  indolent  class,  you 
will  of  course  make  use  of  the  proper  stimulants.  I 
have  found  the  application  of  moderately  warm  vapor, 
for  a  considerable  length  of  time,  a  specific  in  many 
cases  of  the  irritable  character.  In  some  constitutions 
a  stream  of  warm  water  answers  the  same  purpose. 

The  only  peculiarity  of  treatment  is  that  called  for 
by  the  engorged  and  enfeebled  state  of  the  veins. 

Among  the  means  for  correcting  this  condition,  is  a 
strong  decoction  of  oak  bark  or  marsh  rosemary,  or  a 
strong  solution  of  alum  or  tincture  of  galls,  kino  or  cate- 


686 


ULCERS. 


chu ;  together  with  stimulants,  such  as  capsicum,  myrrh, 
prickly  ash  or  southern  prickly  ash,  (tooth-ache  tree.) 

In  addition  to  your  stimulants  and  astringents,  apply 
strong  compression  by  means  of  a  roller,  beginning,  of 
course,  at  the  extremity  of  the  limb,  and  carrying  it 
above  the  sore,  or  any  veins  visibly  enlarged,  and 
making  the  pressure  bear  equally  on  every  part,  or  if 
there  is  any  difference,  be  sure  that  it  is  not  greater 
above  than  below. 

These  measures  generally  succeed;  if  they  do  not, 
scarify  the  parts,  continue  to  use  your  rolle^^md  as- 
tringents. 

Sometimes  the  principal  veins  around  the  ulcer  have 
to  be  taken  up.  In  passing  your  needle  under  the  ves- 
sel, be  careful  not  to  wound  it.  When  it  is  through, 
coil  a  wax  thread  over  it  in  form  of  a  figure  8,  so  as  to 
stop  the  circulation.  Sometimes  two  or  three  darns  are 
necessary  at  a  little  distance  apart.  Keep  up  the  pres- 
sure on  the  vein,  till  the  necessary  degree  of  inflamma- 
tory action  for  adhesion  is  brought  about.  Watch  it 
scrupulously,  however,  lest  you  make  a  new  ulcer,  as 
troublesome  as  that  which  you  are  trying  to  cure.  Ke- 
move  your  needles  as  "soon  as  you  perceive  the  least 
sign  of  ulceration. 

This  obliteration  of  the  veins  by  ligature  is  much 
recommended,  among  other  authorities,  by  M.  Phil- 
lips, surgeon  to  the  Marylebone  Infirmary,  London.  It 
is,  however,  a  very  painful  and  troublesome  process,  and 
few  patients  will  submit  to  it.  I  therefore  prefer  another 
mode  of  effecting  the  object.  Cauterize  each  vein,  (with 
potassa  fusa,)  from  one  to  two  inches  from  the  ulcer. 
In  the  cicatrix,  which  is  formed,  the  vein  is  effectually 


ULCERS. 


G87 


obliterated.  You  need  be  under  no  apprehension  of 
healing  the  caustic  ulcer,  (as  you  must  be  in  that  of  the 
ligature,)  such  a  stimulous  is  given  to  the  part  that  it 
will  only  require  a  simple  emollient  dressing,  which 
should  be  applied  as  soon  as  the  parts  disorganized  by 
the  caustic  have  sloughed  off.  Any  irritation  excited 
in  the  surrounding  parts  must  be  reduced  before  we  can 
re-apply  the  roller  as  firmly  as  before. 

The  constitutional  treatment  should  be  more  or  less 
of  what  I  directed  when  speaking  of  indolent  or  irritable 
ulcei^A 

Old  Sore  Legs. —  Chronic  Ulcers. — Fever  or  Brandy 
Sores. — This  is  a  subject  of  much  importance  in  our 
State,  and  although  Prof.  Hill  has  used  the  truly 
descriptive  and  not  very  classical  name  of  "  old  sore 
legs,"  yet  withal,  it  is  a  character  of  ulcer  which  is  com- 
mon and  quite  prevalent.  We  could  hardly  do  better 
than  to  quote  him  entirely;  and  where  I  shall  make 
additions  or  suggestions  in  the  treatment,  it  will  be  found 
in  parenthesis. 

That  Old  Sore  Legs  is  of  more  importance  than  any 
of  the  others  must  be  evident,  if  for  no  other  reason 
than  this,  that  it  includes  all  the  others,  the  same  limb 
often  producing  specimens  of  the  indolent,  the  irritable, 
the  varicose  ulcer,  and  perhaps,  too,  at  the  same  time, 
one  or  two  in  a  tolerably  healthy  condition. 

Although  the  patient  is  apparently  well,  and  will  tell 
you  that  his  general  health  is  perfect,  he  is  often  more 
or  less  lamed,  (the  ulcers  being  deep,)  and  suffers  much, 
particularly  at  night.  The  chief  suffering  is  from  the 
heated  state  of  the  parts,  which  is  so  great  that  cold 
water  affords  no  sensible  relief,  and  you  will  often  find 
that  even  in  the  coldest  nights,  he  lies  with  the  limb 


GS8 


ULCERS. 


entirely  uncovered.  But  grown  accustomed  to  the  evil, 
and  faithless  as  to  any  remedy,  the  sufferer  makes  no 
complaints,  and  calls  for  no  aid. 

What  I  wish  to  call  your  attention  to  more  particu- 
larly, aside  from  the  character  of  the  ulcers  themselves,  is 
the  condition  of  the  limb.  This  is  hardened  as  well  as 
swollen ;  and  frequently  from  the  ankle  to  the  knee,  is 
as  dark  as  a  negro's  leg.  Where  the  cuticle  scales  off, 
as  often  happens,  it  leaves  a  shining,  bluish  or  livid 
surface,  which  becomes  white  on  pressure  with  the 
finger.  * 

In  actual  treatment,  the  condition  of  the  ulceWrnust 
be  first  considered,  though  they  are  in  reality  of  trifling 
importance  compared  with  the  condition  of  the  limb, 
which  latter  requires  treatment  just  as  much,  whether 
at  the  time  there  happen  to  be  open  sores  on  it  or  not. 

If  the  ulcers  are  of  the  indolent  character,  with  thick 
tough  pus  adhering  to  the  bottom,  hard  callous  edges 
turned  outward,  &c. ;  your  first  care  must  be  to  cleanse 
them  thoroughly.  (In  general,  there  is  a  free  discharge 
of  a  tenacious  matter  from  the  sore,  differing  essentially 
from  the  healthy  pus.  This  kind  of  ulcer  is  in  almost 
every  instance,  seated  in  the  leg,  and  the  nearer  it  is  to 
the  ankle,  the  more  difficult  it  is  to  cure.)  Your  best 
means  for  this  purpose,  is  the  mild  powdered  caustic, 
filling  or  completely  covering  the  ulcer  with  it,  and  then 
putting  on  a  slippery  elm  poultice.  This  dressing  should 
be  renewed  as  often  as  every  ten  or  twelve  hours. 
(Bayberry  and  elm  make  a  good  poultice,  every  one 
who  has  had  much  experience  with  ulcers  of  long 
standing,  must  have  noticed  the  necessity  of  occasionally 
changing  the  local  treatment.  An  application  that  is 
beneficial  at  one  time,  may  prove  perfectly  useless  at 


ULCERS. 


G89 


another.    The  bark  of  the  root  of  the  wild  indigo, 
mashed  to  a  pulp,  and  thoroughly  combined  with  slip- 
pery elm  so  as  to  form  a  soft  poultice,  is  a  most  valu- 
able application  in  indolent  ulcers  upon  the  leg.  Pre- 
pared chalk  and  linseed  oil,  rubbed  together  to  the  con- 
sistence of  putty,  and  applied  to  old  ulcers,  is  recom- 
mended.)   In  the  course  of  thirty-six  or  forty-eight 
hours,  the  pus  will  easily  wash  off,  and  the  sore  present 
a  florid  and  comparatively  healthy  appearance ;  and  the 
edges  especially,  be  much  softened.    If,  on  the  other 
hand,  there  should  be  any  irritable  ulcers,  emollients 
must  be  resorted  to.    The  whole  limb  must  be  subjected 
to  the  vapor  of  bitter  herbs  and  water.    The  best  way 
is  to  place  it  over  a  vessel,  into  which  the  ingredients 
are  put  with  boiling  water  and  vinegar,  steam  being- 
kept  up  by  hot  bricks,  covering  the  whole  with  a  blanket 
to  prevent  the  escape  of  the  vapor.    Eepeat  it  at  least 
once  every  other  clay ;  meantime,  bathe  the  affected 
limb  with  some  stimulating  wash,  one  composed,  for 
instance,  of  the  spirits  of  turpentine,  one  ounce,  and 
tinctures  of  cayenne  pepper  and  camphor,  each  two 
ounces,  sheathing  the  ulcer  from  its  effects,  for  a  while, 
by  a  simple  cerate  spread  on  linen.     This  liniment 
should  be  applied  to  the  leg  immediately  after  steaming 
it. 

When  these  points  are  attended  to,  proceed  with 
your  most  important  measure — the  bandage.  (In  cases 
of  old  sores,  and  in  all  cases  where  an  ulcer  is  spongy 
or  contains  proud  flesh,  it  is  important  to  apply  regular 
pressure,  with  a  view  to  support  the  capillary  vessels  of 
the  part.)  Your  bandage  should  be  almost  two  inches 
and  a  half  wide.  Begin  with  it  at  the  extremity  of  the 
great  toe,  so  as  to  compress  it  equally  all  around.  At 

44 


690 


ULCERS. 


the  next  turn,  include  the  second  tie,  and  so  on  with 
the  others  one  at  a  time ;  then  go  on  firmly  and 
smoothly,  all  over  the  foot,  first  placing  compresses  in 
the  hollows  around  the  ankle,  so  as  to  have  equal  pres- 
sure at  every  point.  Continue  to  the  knee,  or  should 
the  state  of  the  limb  require  it,  include  even  the  thigh 
also;  one  of  the  principal  objects  being,  you  should 
bear  in  mind  to  aid  the  returning  circulation.  Let  each 
layer  of  your  roller  over-lap  the  preceding  for  at  least 
two-thirds  of  its  width.  Where  the  limb  is  tapering, 
(as  just  above  the  ankle,)  it  will  not  lie  smooth  unless 
you  fold  it  over  itself,  and  slighly  change  its  direction 
at  almost  every  turn.  When  you  have  reached  the 
knee,  or  as  high  as  you  wish  to  go,  bring  it  in  the  same 
manner,  down  to  the  foot  again,  taking  care  to  use  no 
more  force  than  before,  lest  you  should  drive  the  blood 
downward. 

I  have  been  thus  particular  about  the  application  of 
the  bandage,  because  if  you  omit  it  your  other  means 
will  probably  be  of  no  avail,  and  if  you  apply  it  badly 
you  may  do  positive  mischief.  Any  part  left  constantly 
uncompressed  by  unskilful  bandaging  will  soon  become 
sore,  and  probably  break  out  in  an  ill-conditioned  ulcer. 

(It  is  a  curious  illustration  of  the  slow  progress  of 
improvement,  that  a  surgeon  of  one  of  the  London  hos- 
pitals or  infirmaries  has  recently  published  a  work,  in 
which  he  advocates  this  measure  as  something  novel. 
Dr.  Morrow  taught  it  as  far  back  as  1830,  and  Prof. 
Duclly,  of  Lexington,  is  well  known  to  have  made  a 
hobby  of  it  for  a  much  longer  period,  the  philosophy  of 
the  bandage  occupying  quite  a  prominent  place  in  his 
course  of  surgical  instruction,  to  the  exclusion,  I  am 
told,  of  nearly  all  other  local  means.) 


ULCERS. 


GDI 


Take  off  and  reapply  the  bandage  every  night  and 
morning,  wetting  it  thoroughly  in  cold  water  each  time 
after  putting  on,  and  as  often  as  it  may  get  dry.  Or  the 
wet  roller  may  be  covered  again  by  dry  ones  or  one  of 
oiled  cloth,  to  prevent  evaporation,  this  may  be  more 
necessary  at  night,  the  patient's  own  sense,  probably, 
keeping  him  attentive  to  it  during  the  clay.  If  the  ban- 
daged limb  is  dipped  in  water,  take  care  that  it  be  not 
kept  in  so  long,  or  that  the  water  (however  applied)  be 
not  so  cold  as  to  occasion  any  sensations  of  chilliness. 

But  a  short  time  will  have  elapsed  under  this  treat- 
ment, continued  from  day  to  day,  before  the  ulcers  will 
have  healed;  but  the  cure  will  still  be  very  far  from 
complete  so  long  as  there  is  any  hardness  or  discolora- 
tion in  the  limb.  For  this  reason  the  same  applications 
should  be  continued. 

If  the  cure  prove  tedious,  change  your  lotions  for 
others  not  less  stimulating,  to  which  should  be  added 
some  strong  vegetable  astringent.  The  system,  or  any 
part  of  the  system  may  get  accustomed  to  a  particular 
article,  yet  retain  its  susceptibility  to  others  of  the  same 
general  character.  Besides  this  alternation  of  washes, 
I  have  often  treated  the  obstinate  limb  with  as  strong  a 
solution  of  the  caustic  (the  sesqui-carbonate  of  potash) 
as  could  be  borne  without  taking  off  the  skin,  or  a  very 
strong  solution  of  the  bi-carbonate,  (saleratus.)  I  regard 
these  alkaline  lotions  as  among  the  most  powerful  dis- 
cutients  in  the  materia  medica  for  all  kind  of  indolent 
swellings,  They  may  be  advantageously  alternated 
with  a  strong  decoction  of  ivlrite  oak  baric. 

After  the  ulcers  have  healed,  the  swelling  gone  down, 
and  the  whole  limb  has  assumed  nearly  its  natural  shape 
and  color,  there  may  still  remain  some  hardened  tumors 


692 


ULCERS. 


resembling  cartilaginous  tubercles,  generally  about  tlie 
ankle.  These  should  be  scarified,  so  as  completely  to 
disorganize  them;  and  the  compression  and  stimulants 
continued.  If  this  is  not  sufficient,  a  caustic  issue  must 
be  made  over  and  into  each,  destroying  every  portion  of 
the  callus.  When  the  cauterized  parts  have  sloughed 
off,  the  issue  will  close  up  and  "leave  not  a  trace  behind." 

Sinuses  also  may  resist  your  ordinary  treatment. 
Inject  them  with  a  very  strong  solution  of  the  mild 
caustic,  and  push  in  tents  charged  with  the  same  in 
substance.  If  they  connect  with  each  other,  bring  them 
together  by  the  ligature  or  the  knife.  If  they  are  near 
the  surface,  cut  them  open,  or  cauterize  down  into  them. 

Among  all  your  applications,  be  sure,  in  treating  this 
form  of  disease,  never  to  apply  any  oily  or  greasy  sub- 
stance. Such  things  often  cause  the  ulcers  to  spread 
and  inflame  very  rapidly.  Most  old  patients  have 
learned  this  by  experience. 

The  importance  of  long  continued  treatment  is  one  point 
more  that  I  wish  you  to  bear  in  mind,  especially  that  of 
compression,  with  stimulating  astringent  washes,  (as  ex- 
tract of  white-oak  bark  and  tincture  of  capsicum,  equal 
parts.)  These  should  be  persevered  with  for  several 
months  after  all  visible  traces  of  the  disease  have  dis- 
appeared. The  limb,  you  should  remember,  has  been 
in  a  preternatural  condition  for  a  long  time,  all  the 
smaller  vessels  at  least  enlarged,  the  fasciae  and  cellular 
tissue  engorged  with  fluids,  and  the  muscles  themselves 
distended  and  put  upon  the  stretch.  By  your  treatment 
you  have  caused  absorption  of  these  extra  fluids,  and 
have  necessarily  left  the  parts  in  a  very  relaxed  state, 
which  can  best  be  corrected  by  astringents  and  compres- 
sion.   In  many  cases  you  must  not  allow  the  patient  to 


ULCERS. 


G93 


leave  off  the  bandage  under  twelve  months,  after  having 
for  some  time  used  it  less  tightly.  And  after  leaving  off 
the  astringent  applications,  cold  bathing  should  be  long 
practised.  Even  when  proper  constitutional  treatment 
has  been  used,  relapses  have  occurred  from  neglecting  this 
attention  to  the  peculiar  change  brought  about  in  the 
limb.  The  patient,  when  apparently  cured,  can  with 
difficulty  be  brought  to  believe  so  much  "  trouble"  neces- 
sary. But  it  is  your  duty  to  make  him  understand  the 
reason  for  his  doing  as  you  desire. 

I  advise  constitutional  treatment,  but  cannot  adopt 
the  course  pursued  in  the  wards  of  the  Philadelphia 
Hospital.  Dr.  Gibson  says,  "  I  have  succeeded  in  nu- 
merous instances,  by  the  use  of  blue  pills,  and  other 
preparations  of  mercury,  after  most  other  means  had 
been  tried  for  months  ineffectually,  and  where  the  pa- 
tient's constitution  has  been  prostrated  by  intemperance, 
I  give  him  wine,  brandy,  opium,"  &c.  This  is  the  con- 
stitutional treatment,  almost  verbatim,  of  one  of  the 
first  Professors  of  Philadelphia,  the  seat  of  medical 
science.  Most  other  means,  the  blue  pill  and  other 
preparations  of  mercury,  with  wine,  brandy  and  opium 
— in  this  age  of  improvement  in  the  medical  profession, 
does  such  teaching  require  comment  ?  If  such  a  guide 
is  blindly  followed,  the  consequences  will  be  fatal.  It 
is  in  many  instances,  that  these  partial  and  superficial 
views,  taken  by  surgeons  and  physicians  in  general,  and 
inconsiderately  presented  in  practical  works,  that  occa- 
sion such  frequent  failures,  and  even  fatal  errors.  In 
the  cases  in  question,  the  general  surface  is,  and  has 
been  for  a  series  of  years,  in  a  diseased  condition,  and 
the  system  at  large  is  as  plainly  out  of  order.  Yet 
opium  and  mercury  are  to  be  prescribed — the  former 


694 


ULCERS. 


being  certain  in  the  end,  to  lessen  the  healthy  action  of 
the  skin  and  other  excreting  surfaces ;  and  the  latter 
having  a  direct  tendency,  when  used  as  recommended, 
to  derange  the  liver  and  stomach,  and  produce,  through 
its  constitutional  influence,  precisely  the  same  sort  of 
local  difficulties  we  are  here  contending  against.  What 
ulcers  are  so  ill-conditioned  and  intractable  as  mercurial 
ones  ? 

Not  in  a  single  instance  do  I  find  any  application 
recommended  for  the  general  surface — that  most  im- 
portant and  most  neglected  of  the  health-preserving  and 
health-restoring  organs — not  even  soap  and  water  does 
he  recommend.  I  adopt  Prof.  Hill's  oonstitutional  treat- 
ment— quite  different  from  the  Professor  alluded  to. 

First  and  foremost,  then,  I  enjoin  upon  you  to  direct 
special  attention  to  the  general  surface.  Make  your 
patient  take  the  alkaline  hand  bath,  (page  40,)  night 
and  morning,  using  brisk  friction  with  the  bare  hand 
and  harsh  towel. 

At  the  end  of  twenty-four  or  twenty-eight  hours,  after 
the  first  application  of  the  roller,  the  patient  will  usually 
experience  pain,  fullness  or  some  disagreeable  sensation 
in  the  head,  with  cough,  nausea,  or  perhaps  some  aching 
in  the  limbs.  The  practitioner  should  be  on  the  look- 
out for  these  occurrences.  They  are,  of  course,  attribu- 
table to  the  absorption  of  the  large  amount  of  unhealthy 
fluids  so  long  retained  in  the  limb, — which,  under  the 
unwonted  mechanical  stimulus  of  the  bandage,  we  often 
find  to  diminish  one-third  of  its  size,  sometimes  even 
one-half,  in  the  course  of  the  first  day.  All  this  matter, 
which  has  so  suddenly  disappeared,  must  have  entered 
the  general  circulation,  and  produced  the  disturbance  of 
the  vital  functions,  evidenced  by  the  disagreeable  symp- 


ULCERS. 


G95 


toms  just  mentioned.  So  soon  as  they  are  noticed,  there- 
fore, or  in  anticipation  of  them,  the  patient  should  take 
a  large  hydragogue  cathartic,  composed  of  comp.  pow- 
der or  syrup  of  senna,  and  cream  of  tartar,  or  some- 
thing similar,  sufficient  to  operate  freely  from  five  to 
ten  times.  Not  the  least  harm  need  be  apprehended 
from  this  purging.  On  the  contrary,  it  will  give  imme- 
diate relief.  It  should  be  repeated,  though  not  to  the 
same  extent,  as  often  as  once  a  iceek,  for  three  or  four 
weeks,  or  more  frequently,  if  any  of  the  above  symp- 
toms re-appear.  By  this  means,  not  unfrequently,  serous 
fluid  to  the  amount  of  from  five  to  ten  pounds,  is  thrown 
out  in  the  course  of  ten  or  twelve  hours,  carrying  with 
it,  no  doubt,  a  large  amount  of  diseased  matter ;  while 
at  the  same  time  such  a  drain  from  the  circulation 
greatly  increases  the  activity  of  the  absorbents,  thus 
aiding  your  local  treatment.  The  patient  must  also  be 
put  under  an  alterative  course,  consisting  especially  of 
such  articles  as  have  a  direct  tendency  to  increase  the 
urinary  secretion.  For  this  purpose,  I  usually  prescribe 
a  syrup  or  strong  infusion,  composed  of  equal  parts  of 
the  root  of  the  leonurus  cardiaca,  (motherwort,)  scrofu- 
laria  Marylandica,  (figwort,)  and  aralia  hispida,  (dwarf 
elder,)  to  be  taken  in  small  quantities,  at  least  three  or 
four  times  a  day ;  or,  instead  of  this,  you  can  give  the 
alterative  syrup,  as  follows  : — 


Sarsaparilla, 

i  lb. 

Liquorice  root, 

li  lbs. 

Burdock, 

li  lbs. 

Sassafras, 

1  lb. 

G  uaiac, 

li  lbs. 

Elecampane, 

Svi. 

Bose  leaves, 

3vi. 

696  ULCERS. 

Make  a  gallon  and  a  half  of  syrup.  This  should  be 
given  in  combination  with  some  active  diuretics. 

If  the  patient  has  been  much  debilitated  by  intem- 
perance or  former  medication,  instead  of  the  foregoing, 
we  first  prescribe  for  a  while  tonic  bitters,  such  as  spike- 
nard, solomon  seal,  gentian,  black  cherry  and  peach 
root,  of  each  one  ounce ;  add  boiling  water  two  quarts ; 
simmer  slowly  down  to  one,  strain,  and  add  two  ounces 
of  loaf  sugar  and  two  quarts  of  wine.  Dose,  wine- 
glassful  three  times  a  day.  Or,  a  syrup  of  prinos  verti- 
cellatus,  (black  alder,)  and  leonurus  cardiaca,  (mother- 
wort,) equal  parts ;  to  be  taken  three  times  a  day,  half 
an  hour  before  each  meal.  I  also  require  the  patient 
to  take  a  draught  of  cold  water  the  first  thing  after 
rising  in  the  morning — at  least  a  common  tumblerful. 
This,  besides  its  tonic  effect,  will  generally  obviate  all 
costiveness ;  if  it  should  not,  he  should  take  small  doses 
of  podophyllin  and  leptandrin,  half  grain  of  the  former 
to  two  grains  of  the  latter,  repeated  every  three  or  four 
hours ;  or,  rhubarb  and  cream  of  tartar  will  answer  all 
the  purposes. 

If  your  patient  be  of  the  scrofulous  diathesis,  give  him 
the  scrofulous  syrup,  as  recommended  in  scrofula.  If 
he  is  laboring  under  the  mercurial  taint,  the  same  may 
be  used  with  advantage,  but  he  should  then  alternate  the 
alkaline  with  the  acid  bath.  Common  cider  vinegar 
answers  this  purpose  best.  He  should  also  be  encou- 
raged to  use  acids  freely  with  his  food,  so  long  as  they 
produce  no  derangement  of  the  stomach. 

The  diet  should  be  plain,  but  palatable  and  nourishing ; 
meat  should  not  be  prohibited.  I  have  frequently  found 
that  patients  restricted  to  a  vegetable  regimen  sank  into 
an  irritable  state,  which  resisted  treatment;  whereas, 


SCALDS  AND  BURNS. 


697 


on  changing  their  diet,  and  allowing  them  more  animal 
food,  they  were  easily  cured.  All  fermented  and  other 
alcoholic  beverages,  however,  should  he  positively  forbid- 
den ;  for,  under  no  treatment,  have  you  reason  to  expect 
a  cure  while  your  patient's  blood  continues  to  be  poi- 
soned." 

Some  persons  teach  the  absurd  doctrine  that  all  sores 
should  not  be  healed ;  this  is  a  humbug.  Restore  the 
general  health,  giving  due  attention  to  all  the  functions, 
particularly  the  excretory,  and  there  will  be  no  clanger 
whatever.  You  do  this,  and  nature  will  be  able  to  pre- 
serve the  general  system  without  the  sacrifice  of  any 
particular  part. 

Mortification. — I  should  have  noticed  this  before.  My 
friend  Dr.  Eogers,  of  Chappel  Hill,  assures  me  that  when 
a  part  is  threatened  with  gangrene,  or  mortification,  the 
yeast,  sassafras,  or  charcoal  poultice,  is  a  valuable  appli- 
cation, and  should  be  kept  wet  with  cold  sassafras  tea 
or  whiskey.  If  the  parts  be  excessively  hot  and  inflamed, 
the  poultice  may  be  kept  wet  with  the  tincture  of  lobelia 
or  with  wild  indigo  root  tea. 

SCALDS  AND  BURNS. 

Scalds  and  Burns. — We  mean  by  this  all  injuries 
caused  by  the  application  of  heat.  "  Greater  injury  may 
be  done  by  oils  and  some  other  fluids,  as  they  can  be 
heated  above  212.° 

u  Scalding  is  likely  to  be  more  superficial,  and  is 
chiefly  dangerous  from  the  extent  of  surface  affected. 

"  Burns,  (including  scalds)  or  the  local  effects  of  great 
heat,  are  divided  into  several  kinds  or  degrees. 

The  first  degree  of  burning  is  where  there  is  only  a 
slight  irritation  produced,  with  redness  of  the  surface 


G98 


SCALDS  AND  BURNS. 


and  the  stinging  and  peculiar  pain,  but  without  vesica- 
tion. The  inflammation,  if  any  is  excited,  terminates 
in  spontaneous  resolution. 

In  the  second  degree  there  is  more  redness  of  the  sur- 
face, in  the  first  instance,  and  this  is  succeeded  by  dif- 
fused vesication.  In  this  variety,  if  you  will  not  punc- 
ture the  distended  cuticle  until  matter  be  formed  beneath, 
the  pain  will  be  but  slight,  and  the  cure  easily  made. 

The  third  degree  is  when  the  heat  is  so  intense  as,  if 
not  directly  to  disorganize  the  surface,  to  so  far  lessen 
its  vitality  as  to  render  destructive  inflammation  inevi- 
table. But  if  the  burn  be  large,  much  constitutional 
irritation  will  generally  attend  it.  The  discharge,  also, 
will  often  be  excessive,  and  accompanied  with  an  offen- 
sive smell.  All  these  symptoms  will  be  worse  if  there 
is  much  constitutional  derangement. 

The  last  degree  is  the  true  burning  up  of  the  part ; 
vitality  being  at  once  destroyed  and  disorganization 
effected.  The  patient,  in  this  case,  experiences  no  pain 
for  a  time,  at  least  none  after  the  first  touch.  If  there 
is  sufficient  power  in  the  system  to  react,  sloughing  takes 
place,  the  eschar  is  thrown  off,  and  a  deep  ulcer  is  formed. 
Not  unfrequently  abscesses  will  form  there,  with  sinuses. 
The  adjacent  bones  or  joints  soon  become  affected.  The 
inflammation  excited  is  sometimes  immediately  followed 
by  extensive  mortification. 

If  the  patient  does  not  die  before  reaction  comes  on, 
the  constitutional  irritation  produces  hectic,  and  he  soon 
sinks  from  exhaustion. 

The  danger  depends  much  upon  the  constitutional 
vigor  of  the  patient  and  upon  the  locality  of  the  burn, 
as  well  as  upon  its  extent.  Children  are  not  so  likely 
to  recover  from  the  effects  of  a  scald  as  adults,  owing  to 


SCALDS  AND  BURNS. 


699 


the  greater  susceptibility  of  their  nervous  systems.  Very 
small  children  are  apt  to  be  thrown  into  spasms,  when 
the  effect  upon  the  brain  proves  speedily  fatal.  Very 
old  persons  suffer  much  less  than  any  others ;  but  erysi- 
pelas sometimes  follows,  which  is  very  difficult  to  con- 
trol. Erysipelatous  inflammation  is  particularly  to  be 
apprehended,  when  the  head  is  the  part  affected.  When 
it  is  the  abdomen,  the  inflammation  is  liable  to  extend 
to  the  vital  organs  beneath.  A  burn  or  scald  on  either 
of  these  locations  is  always  to  be  regarded  as  dangerous, 
and  proportionally  more  dangerous  as  the  patient  is 
younger.  A  slight  injury  of  this  kind  upon  the  scalp 
is  to  be  looked  upon  with  suspicion ;  and  you  should 
take  care  to  heal  as  soon  as  possible  when  upon  the 
abdomen.  Burns  upon  the  genital  organs  are  very  hard 
to  cure,  and  give  rise  to  strong  constitutional  symp- 
toms, in  consequence  of  their  peculiar  susceptibility  and 
great  sympathy  with  all  the  vital  functions.  Upon  the 
course  of  the  tendons,  these  wounds  tend  more  than  any 
other  to  produce  contraction,  and  where  nerves  are  also 
involved  in  the  eschar,  or  contraction,  there  will  be  dan- 
ger for  a  long  time  after,  of  tetanus,  or  neuralgia.  Vio- 
lent constitutional  symptoms  follow  an  extensive  burn, 
let  it  be  in  what  part  it  may.  There  will  at  first  be 
rigors,  disturbed  and  oppressed  respiration,  and  general 
depression,  with  a  pulse  for  a  time  low  and  feeble ;  but, 
if  there  is  sufficient  vigor  in  the  system  for  reaction,  the 
subsequent  inflammatory  fever  is  often  very  violent. 

Scalds,  unless  when  caused  by  hotter  liquids  than 
boiling  water,  or  unless  the  part  should  remain  in  the 
hot  water  long  enough  to  be  itself  boiled  or  cooked, 
belong  to  the  second  degree,  in  which  nothing  worse 
than  vesication  is  the  necessary  result.  Generally,  there- 


700 


SCALDS  AND  BURNS. 


fore,  their  only  danger  is  from  the  extent  of  surface 
involved." 

Treatment — To  treat  scalds  and  burns  successfully, 
your  first  object  must  be  to  apply  such  remedies  as  will 
effectually  exclude  the  burnt  parts  from  the  action  of 
the  atmosphere.  For  slight  affections  of  this  character, 
especially  if  the  skin  be  not  destroyed,  the  best  applica- 
cation  is  cold  water,  or  applying  linen  or  muslin  cloths 
on  the  parts,  kept  wet  with  cold  water  or  whiskey  and 
water.  This  should  be  applied  until  the  smarting 
ceases,  (always,  however,  bearing  in  mind,  when  you 
resort  to  cold  water,  not  to  expose  the  parts  so  long  to 
its  application  as  to  occasion  any  sensations  of  chilli- 
ness.) The  parts,  after  this  application,  should  be 
covered  with  lime  water  and  oil.  The  following  recipe 
I  use,  viz. : 

Linseed  oil,  fl.siii. 
Lime  water,  fl.Svi. 

Make  a  linament  and  apply  to  the  burnt  surface.  If 
there  is  much  pain  I  acid  two  fl.  ounces  of  laudanum  to 
this  prescription ;  or  you  can  make  an  application  of  the 
black  salve,  and  cover  the  parts  with  oiled  silk. 

In  many  instances,  where  you  have  to  resort  to  the 
best  application  at  hand,  I  advise  common  flour  to  be 
dusted  on  the  part  ;  a  better  mode,  probably,  is  to  wet 
the  flour  with  vinegar,  and  apply  the  paste  to  the 
abraded  surface. 

When  blisters  are  formed  they  should  be  punctured 
with  a  needle,  and  the  parts  should  be  covered  with  a 
thick  layer  of  carded  cotton,  kept  damp  with  alcohol 
and  water,  and  continued  until  the  parts  cease  to  be 


SCALDS  AND  BURNS. 


701 


painful,  after  which  you  should  apply  the  linament 
above,  or  the  black  salve. 

When  the  outer  skin  is  removed  at  the  time  of  a  burn 
or  scald,  the  most  emollient  application  is  the  best,  and 
none  will  be  found  superior  to  pulverized  slippery  elm, 
mixed  with  milk  and  linseed  oil ;  this  should  be  immedi- 
ately applied  to  exclude  the  atmosphere,  (every  family 
should  keep  it  in  the  house,)  and  you  should  avoid 
removing  the  dressing  until  several  hours,  or  even  a  day 
or  more  has  elapsed.  If  the  parts  are  entirely  insensi- 
ble, some  stimulant  should  be  added,  such  as  brandy 
or  the  tincture  of  capsicum  or  of  myrrh.  In  this  case 
cold  applications  must  be  strictly  proscribed,  especially 
if  the  patient  be  chilly. 

Poultices  of  scraped  potatoes  or  carrots,  mixed  in  the 
same  manner  are  good  applications,  but  nothing,  in  my 
opinion,  is  equal  to  the  slippery  elm  preparation.  The 
poultice  will  require  to  be  moistened  occasionally;  and 
when  the  parts  are  suppurating  freely  a  fresh  one  must 
be  applied  daily,  until  the  suppuration  is  completed, 
when  the  black  salve  should  be  applied  until  the  wound 
is  healed.  When  granulations  shoot  up,  forming  what 
is  termed  fungous  flesh,  it  must  be  touched  with  mild 
escharotics,  or  finely  powdered  marsh  rosemary,  at  each 
time  the  dressing  is  removed. 

Numerous  applications  for  burns  and  scalds  are  in 
high  repute  with  the  profession,  and  amongst  Southern 
practitioners,  rum  and  Orleans  molasses  has  been  much 
extolled ;  I  have  tried  it  in  some  instances,  and  confess 
it  surpassed  my  expectations ;  it  can  be  applied  with 
cotton  or  slippery  elm. 

Constitutional  symptoms. — Generally  occasion  great 
prostration  of  the  powers  of  life,  more  particularly 


702 


SCALDS  AND  BURNS. 


manifested  by  chilliness,  coldness  of  the  surface,  extreme 
prostration  of  strength,  a  weak  pulse,  and  sometimes 
stupor  or  delirium;  under  these  circumstances,  the 
symptoms  "must  be  watched  and  met  in  all  cases  of 
serious  burning.  If  the  patient  be  much  prostrasted, 
he  may  need  stimulants,  but  care  should  be  taken  that 
stimulation  be  not  carried  too  high  or  kept  up  too  long ; 
for  when  reaction  comes  about,  the  consequent  fever  is 
apt  of  itself,  to  need  means  for  restraining  its  violence. 
As,  however,  it  is  desirable  to  effect  this  object  without 
excessive  depletory  or  weakening  measures,  it  is  better  in 
the  first  place,  to  avoid  adding  in  any  degree  to  the  excite- 
ment, by  stimulation.  Diaphoretics  will  very  often  be 
requisite.  Among  the  most  valuable,  is  a  strong  infusion 
of  the  asclepias  tuberosa,  (pleurisy  root,)  taken  freely. 
To  this  may  be  added  the  monardo  punctata,  (horse- 
mint,)  or  the  origanum  majorana,  (sweet  margorum). 
If  there  is  much  nervous  irritation,  the  Scutellaria 
(scullcap)  should  be  added.  Active  but  mild  cathar- 
tics should  be  used.  They  should  be  repeated  vigo- 
rously, when  the  brain  becomes  affected,  as  it  frequently 
does,  from  continued  nervous  irritation,  counterirritants 
and  revulsives  must  not  be  forgotten  in  that  event, 
though  still  the  most  important  means  by  far,  is  the  re- 
moval of  the  cause,  by  allaying  the  original  irritation 
at  its  source.  An  important  caution  for  those  who  are 
not  accustomed  to  these  cases,  is  to  keep  fingers,  toes 
and  other  contiguous  parts,  from  coming  in  contact  with 
the  abraded  surface.  Another  cause  of  deformity  to  be 
guarded  against,  is  the  contraction  of  muscles  and 
tendons.  For  this  danger,  you  must  study  the  anatomy 
of  the  parts,  and  resist  the  tendency  with  suitable 
splints  or  other  modes  of  applying  force,  flexing  or 


SCALDS  AND  BURNS. 


703 


extending,  as  the  case  may  require.  When  this  pre- 
caution has  been  neglected,  the  case  is  not  quite  irreme- 
diable. The  contracted  tendons  can  be  divided,  when 
necessary,  though  I  have  hitherto  found  it  necessary  in 
any  cases  that  have  fallen  into  my  hands  for  repair,  to 
dissect  away  the  adhesions.  Severe  burns  on  the  neck 
are  almost  necessarily  followed  by  more  or  less  defor- 
mity. A  severe  burn  on  the  elbow  or  on  the  inside  of 
the  arm  at  the  elbow,  would,  whilst  healing,  naturally 
tend  to  bend  the  arm ;  and  if  allowed  to  heal  in  this 
position,  the  patient  will  be  unable  to  straighten  the 
arm.  This  deformity  can  be  prevented  by  applying  a 
splint  to  the  back  of  the  arm,  so  as  to  keep  the  limb 
straight. 

I  have  attached  some  remedies  that  are  highly 
extolled,  and  no  doubt  in  many  instances,  will  be  found 
useful. 

Contused  root  of  wild  indigo,  Sii. 
Lard,  Bxi. 

Simmer  together  for  an  hour,  and  strain.    This  has 
been  found  beneficial  to  burns  ;  or, 
^.    Yolk  of  one  egg. 
Flaxseed  oil,  §ii. 
Mix  well.    As  an  application  to  burns,  some  substi- 
tute the  white  of  the  eggs  for  the  yolk. 

Flaxseed  oil  liniment  is  highly  extolled : 
Flaxseed  oil,  Sxii. 
Lime  water,  gvii. 

Mix.    As  an  application  to  burns  and  scalds. 


704 


WORMS. 


VERMES. 

Worms. — There  is  quite  a  variety  of  worms.  Some 
authors  contend  there  are  five  different  species  inhabit- 
ing the  alimentary  canal. 

1.  Ascaris  lumbricoicles. — The  large  round  worm. 
This  species  varies  in  length  from  three  to  ten  or  twelve 
inches,  and  about  the  size  of  a  goose  quill;  it  is  supposed 
by  some  to  have  some  identity  with  the  common  earth 
worm,  from  which,  however,  it  is  wholly  distinct. 

2.  Ascaris  vermicidaris,  or  thread  worm. — It  is  the 
smallest  of  the  intestinal  worms,  the  male  not  exceeding 
two  lines,  and  the  female  being  about  five  lines  in 
length. 

3.  Tricoceplialus  cllspar. — Long  thread  worm.  This 
somewhat  resembles  No.  2  in  formation,  with  this  differ- 
ence, that  this  worm  is  an  inch  or  two  in  length,  and 
consists  of  two  distinct  portions. 

4.  Taenia  solium. — Common  tape  worm.  The  taenia 
varies  much  in  length,  generally  found  from  two  to 
twelve  feet  in  length,  but  sometimes  reaching  from  sixty 
to  one  hundred  feet.  I  have  in  my  possession  a  piece 
that  was  passed  by  a  patient  of  mine,  thirty-two  feet 
long ;  they  are  nearly  a  half  inch  in  breadth,  flat,  white, 
and  composed  of  a  series  of  joints. 

5.  BotliriocepJialus  latus. — Broad  tape  worm.  This 
worm  is  also  long  and  flat,  but  is  broader  than  the  com- 
mon tape  worm ;  it  is  distinguished  by  the  shape  of  the 
segments,  which  are  broader  than  they  are  long. 

Symptoms. — Where  there  are  worms  in  the  stomach  or 
bowels,  you  have  paleness  of  the  countenance,  with  occa- 
sional flushes  on  the  cheeks,  picking  the  nose,  variable 


WORMS. 


705 


appetite,  sometimes  voracious,  at  other  times  entirely 
gone,  copious  secretion  of  saliva,  and  a  furred  tongue, 
swellings  of  the  upper  lip,  bleeding  from  the  nostrils, 
and  a  disposition  to  grind  the  teeth  during  sleep,  also 
the  belly  is  swollen,  hard,  and  tympanitic,  with  trans- 
cient  pains  through  the  bowels,  and  starting  in  the  sleep. 
These  symptoms,  however,  may  all  exist  independently 
of  the  presence  of  worms,  and  even  when  there  are 
worms,  most  of  the  attending  symptoms  may  arise  from 
a  disordered  condition  of  the  stomach  and  bowels.  A 
febrile  condition  occasionally  accompanies  worms,  with 
daily  exacerbations  and  remissions,  offensive  breath,  and 
frequently  symptoms  of  cerebral  oppression. 

An  author  who  has  had  much  experience,  says,  as  to 
many  of  the  abo\e  disordered  conditions,  it  is  often  im- 
possible to  say  whether  they  bear  to  the  worms  the 
relation  of  cause  or  effect,  and  sometimes  whether  the 
connection  may  not  be  a  mere  coincidence.  That  worms 
are  sometimes  the  cause,  may  be  inferred  from  the  fre- 
quently observed  fact,  that  all  the  phenomena  vanish 
when  they  are  removed.  Again  it  is  well  known  that 
disordered  digestion  and  general  debility  favor  the  pro- 
duction of  worms;  and  the  same  causes  which  give  rise 
to  the  development  of  these  parasites  are  quite  sufficient 
to  produce  various  derangements  by  their  direct  action, 
wholly  independent  of  the  worms;  so  that  the  two  may 
coexist  without  any  necessary  connection  as  cause  and 
effect. 

Treatment. — There  is  some  difficulty  in  ascertaining 
whether  a  person  has  worms  or  not;  but  your  object 
should  be  to  expel  the  worms  from  the  bowels,  and 
afterwards  to  prevent  their  reproduction. 

Your  best  mode  to  expel  worms  from  the  bowels  is  to 
45 


706 


WORMS. 


combine  purgatives  with  anthelmintics,  or  you  may 
administer  the  latter  night  and  morning,  for  a  few  days, 
afterwards  ordering  the  cathartics. 

Anthelmintics  are  medicines  which  prove  disagreeable 
to  the  worms,  and  thereby  dispose  them  to  leave  the 
bowels,  or  so  debilitate  them  as  to  disable  them  from 
maintaining  their  position,  or  destroy  their  life,  and 
thus  expose  them  to  the  expulsive  powers  of  the  intes- 
tines, or  the  digestive  powers  of  the  stomach.  They 
may  produce  these  effects,  by  acting  on  the  susceptibili- 
ties of  the  worm,  as  medicines  and  poisons  act  on  the 
human  system,  or  by  mechanically  bruising  or  wound- 
ing it.  Among  those  which  operate  in  the  former 
method,  may  be  mentioned  pink-root,  azedarach,  the  bark 
of  Anclira  inermis,  male  fern,  the  bark  of  pomegranate 
root,  kosso,  walnut-rind,  common  salt,  camphor,  various 
bitters,  and  numerous  substances  characterized  by  con- 
taining a  strongly  odorous  or  highly  stimulating  volatile 
oil,  as  turpentine,  copaiba,  savine,  chenopodium  or  Ameri- 
can wormseed,  semen  santonicce  or  European  wormseed, 
tansy,  rue,  wormivood,  garlic,  and  assafoetida.  Several 
of  the  volatile  oils  themselves  are  still  more  efficacious, 
especially  the  oil  of  turpentine  and  that  of  chenopodium. 
Electricity  passed  through  the  bowels,  in  successive  and 
somewhat  violent  shocks,  has  been  supposed  to  injure 
or  kill  the  worms,  and  favour  their  expulsion  by  cathar- 
tics. The  mechanical  anthelmintics  are  chiefly  cow- 
hage,  which  wounds  and  sometimes  destroys  the  worms 
by  the  sharp  bristles  of  its  pods,  and  the  powder  of  tin 
or  of  zinc,  which  bruises  or  scratches  them  by  its  angu- 
lar particles.  Metallic  mercury,  which  has  been  recom- 
mended in  worms,  undoubtedly  operates  by  its  great 
weight.    The  fixed  oils  are  thought  by  some  to  operate 


WORMS. 


707 


as  anthelmintics,  by  covering  the  surface  of  the  worm, 
and  thus  closing  its  respiratory  pores  against  the  entrance 
of  air. 

In  the  choice  of  purgatives,  attention  should  be  paid 
to  their  anthelmintic  properties.  Thus,  calomel  is  a 
powerful  vermifuge,  much  more  so  than  can  be  satisfac- 
torily explained  by  a  reference  to  its  mere  cathartic 
power.  The  probability  is,  that  it  proves  disagreeable 
or  injurious  to  the  worm  by  the  acrid  property  of  the 
bile  which  it  causes  to  be  secreted.  Aloes  is  also 
thought  to  possess  vermifuge  properties,  independently 
of  its  purgative  action,  owing  to  its  intense  bitterness ; 
this  property  being  considered  by  some  as  extremely 
offensive  to  worms.  The  same  maybe  said  of  coloc/j  nth. 
If  there  is  truth  in  the  supposition  before  alluded  to,  of 
the  suffocating  action  of  fixed  oils  on  the  worms,  which, 
however,  is  by  no  means  certain,  at  least  in  reference  to 
the  operation  of  these  oils  when  taken  into  the  stomach. 
castor  oil  and  olive  oil  ought  to  be  efficacious  anthelmin- 
tics. The  oil  of  turpentine  in  very  large  doses,  and  the 
hark  of  pomegranate  root,  unite  purgative  and  anthel- 
mintic powers.  Considered  independently  of  anthel- 
mintic properties,  those  cathartics  are  the  most  power- 
fully vermifuge,  which  act  with  greatest  energy  on  the 
muscular  coat  of  the  bowels.  Senna,  jalap,  scammony, 
aloes,  black  hellebore,  cevadilla,  colocjmth,  gamboge, 
croton  oil,  and  elaterium  have  been  used,  variously  com- 
bined, and  in  various  modes  of  preparation. 

1.  Round  Worm,  xlscaris  Lumbricoides. — The  round 
worm  generally  inhabits  the  small  intestines,  but  not 
unfrequenth'  makes  it  way  upward  into  the  stomach,  or 
downward  into  the  rectum ;  and  sometimes  escapes  from 
the  alimentary  canal  by  the  mouth,  or  by  the  anus.  It 


708 


WORMS. 


occasionally  enters  other  passages  which  communicate 
with  that  canal;  having  been  found  in  the  posterior 
nares,  the  trachea,  the  pancreatic  and  biliary  ducts3  and 
the  gall-bladder.  It  is  sometimes  solitary,  but  more 
generally  in  considerable  numbers;  and  two  hundred 
have  been  known  to  pass  from  one  patient  in  the  course 
of  a  week.  The  worm  is  supposed  to  feed  upon  the 
intestinal  mucous,  which  is  usually  copious  where  these 
parasites  exist.  It  occurs  most  frequently  in  children, 
occasionally  in  adults,  and  seldom  in  old  persons.  Of 
all  the  different  worms  that  infest  the  bowels,  this  is 
usually  considered  as  by  far  the  most  common,  and  cer- 
tainly is  so,  with  the  exception  of  the  Tricocephalus. 

The  symptoms  are  those  already  enumerated  as  re- 
sulting from  intestinal  wrorms  in  general.  The  most 
characteristic  signs  are  perhaps  a  tumid  abdomen,  irregu- 
larity of  the  bowels,  depraved  appetite,  picking  of  the 
nose,  and  grinding  of  the  teeth  in  sleep.  When  these 
worms  exist  in  the  stomach,  they  occasion  peculiar 
deranged  sensations  in  the  epigastrium,  with  nausea, 
and  frequent  retching,  and  motions  on  the  part  of  the 
patient  as  if  he  were  choking  from  something  in  the 
throat,  produced  probably  by  attempts  of  the  w^orm  to 
enter  the  oesophagus,  or  by  its  actual  presence  in  that 
tube.  When  these  motions  occur  in  an  infant,  the  round 
worm  may  be  suspected  to  exist  in  the  stomach.  But 
the  only  certain  proof  that  a  patient  is,  or  has  been 
laboring  under  this  worm,  is  the  sight  of  it  after  it  has 
passed  from  the  bowels,  or  been  discharged  from  the 
stomach.  It  sometimes  comes  away  spontaneously  from 
the  anus,  and  is  not  unfrequently  evacuated  with  the 
faeces,  thus  affording  the  requisite  evidence  of  its  ex- 
istence. 


WORMS.  * 


709 


The  general  course  of  treatment  for  worms  already 
described  is  applicable  to  this  species.  A  good  remedy 
at  the  commencement,  and  one  which  will  alone,  in  a 
great  majority  of  cases,  produce  an  evacuation  of  the 
worms,  is  an  infusion  of  senna  and  pink-root,  with  sul- 
phate of  magnesia  to  correct  the  griping  property  of  the 
cathartic,  manna  to  cover  the  taste,  and  fennel-seed  or 
other  aromatic  to  correct  the  flavor,  and  to  render  the 
whole  more  acceptable  to  the  stomach.  This  infusion 
may  be  given  in  a  small  dose  once  or  twice  a  day,  so  as 
to  produce  two  or  three  evacuations  in  the  twenty-four 
hours,  and  may  be  continued  daily,  twelve  every  other 
day  for  one  or  two  wreeks." 

A  good  recipe  is  the  following  in  red  worms  or  brown 
worms,  viz. : 

Ify.  Sennae, 

Spigelia,  aa.  Bss. 
Sul.  magnesia,  5ii. 
Manna,  gi. 
Fgeniculi,  3ii. 
Aquae  fervent,  Oj. 
To  be  macerated  for  two  hours  in  a  covered  vessel. 
Dose. — For  a  child  two  years  old,  about  fl.Sss.,  for  an 
adult,  fl.Siii.  or  iv. 

Cowhage,  given  in  molasses  or  arrow-root,  is  a  good 
vermifuge.  To  a  child  from  one  to  two  j^ears  old,  one 
fourth  of  a  tea-spoonful  twice  a  day.  Every  third  day 
it  should  be  followed  by  a  tea  of  common  salt  and  senna, 
equal  parts ;  give  enough  to  purge. 

Tape  Worm. — They  are  very  difficult  to  remove, 
adhering,  I  believe,  with  great  tenacity  to  the  mucous 
crust  by  means  of  suction.    The  remedies  at  present 


710 


f  WORMS. 


most  relied  on  for  their  expulsion  are  oil  of  turpentine  and 
an  Abysininian  product  called  Kosso.  It  has  recently 
acquired  much  reputation  as  a  remedy  for  tape  worm, 
and  from  the  numerous  reports  in  its  favor,  there  can 
be  but  little  doubt  of  its  great  efficacy. 

"Various  other  remedies  have  been  recommended. 
Schmucker  employed  powdered  cevadiUa  in  the  dose  of 
half  a  drachm  daily,  or  half  the  quantity  twice  a  day, 
interposing  an  occasional  purge.  Mare's  milk  is  asserted 
to  have  been  used  with  great  advantage  in  Germany. 
Hufeland  associated  a  decoction  of  garlic  in  milk  with 
castor  oil  and  tin  filings.  Wawruch  used  salicin  in 
doses  of  from  two  to  six  grains  every  two  hours,  with 
advantage  in  some  cases.  Dr.  S.  J ackson,  late  of  North- 
umberland, showed  the  author  a  portion  of  tape-worm, 
(taenia  solium,)  thirty  feet  long,  which  had  been  dis- 
charged by  a  female  patient  of  his,  upon  taking  a  dose 
of  castor  oil,  after  having  been,  for  two  months,  upon 
the  use  of  half  a  fluidounce  of  olive  oil,  night  and  morn- 
ing, to  obviate  constipation.  Mr.  Whittel  has  found 
oxide  of  silver,  in  the  dose  of  a  grain,  repeated  occasion- 
ally, effectual  in  two  cases.  Half  a  pint  of  an  infusion, 
made  with  two  ounces  of  pumpkin  seeds  and  a  pint  of 
boiling  water,  taken  after  fasting  for  twenty-four  hours, 
and  followed  in  an  hour  or  two  by  a  dose  of  castor  oil, 
is  said  to  have  proved  effectual  after  failure  with  the 
most  powerful  anthelmintics.  Sometimes  a  portion  of 
an  unbroken  worm  passes  out  through  the  anus,  while 
the  remainder  continues  within  the  bowels.  Caution  is 
here  requisite  not  to  break  the  worm  in  attempting  to 
extract  it.  Brera  recommends  that  it  should  be  tied 
with  a  piece  of  silk.  When  thus  treated,  though  the 
worm  may  draw  itself  within  the  bowel,  it  begins  to 


WORMS. 


711 


descend  again  not  long  afterwards.  Dr.  Cagnola  pro- 
posed to  touch  the  extruded  portion  with  hydrocyanic 
acid,  in  the  expectation  that  this  poison  would  destroy 
the  worm ;  and  the  experiment  was  successfully  tried 
by  Dr.  Garleke.  Caution,  however,  would  be  requisite 
not  to  incur  the  risk  of  injuring  the  patient.  Dr.  Frank, 
of  St.  Petersburg,  succeeded  in  withdrawing  the  taenia 
whole,  by  passing  the  part  without  the  bowel  through  a 
canula,  and  introducing  this  into  the  rectum,  so  as  to 
overcome  the  resistance  of  the  sphincter-ani." 


Note. — The  fear  of  making  our  volume  too  cumbersome  has  compelled  us  to 
omit  a  few  articles  prepared  for  this  work.  The  diseases  upon  which  they 
treated,  (Ovarian  Dropsy,  &c.,)  are  so  rare  in  this  climate  that  a  description 
of  them  would  have  been  almost  superfluous. 


EXPLANATION  OF  THE  PRINCIPAL  ABBREVIATIONS. 


fy.  Recipe — Take. 

M.  Misce— Mix. 

Sol.  Solve — Dissolve. 
Ana,  or  aa — Of  each. 

Qs.  Quantum  Sumciat — As  much  as  will  suffice. 

Lb.  Libra — A  pound. 

%.  Uncia — An  ounce. 

3.  Drachma — A  drachm  or  dram. 

3.  Scrupulum — A  Scruple. 

Gr.  Granum — A  grain. 

Pulv.  Pulvis — A  powder. 

Tine.  Tinctura — A  tincture. 

Ext.  Extractum — An  extract. 

0.  Octarius — A  pint. 

ft.  Fluid  uncia — A  fluid  ounce. 

f3.  Fluidrachma — A  fluid  drachm. 

Ss.  Semissis — A  half.    iss.    One  and  a  half. 

F.  M.  Fiat  Misturae — Make  mixture. 


INDEX. 


Page. 


A. 

Abdomen,  Inflammation  of,  .  59 
"  Dropsy  of  the,  .  527 
"  "       Diagnosis  of,  .  527 

"  "       Pregnancy  mis- 

taken for,  529 
"  "       Causes  of,  531 

"  "       Treatment  of,  532 

"  "       Tapping  in,  536 

"  "      Diet  for,        .  538 

Acid  Bath,         .  .  .40 

Ague,  (see  Intermittent  Fever,)  82 
"  Complications  of,  .  84 
"     Prevention  of,      .  .  90 

Alimentary  Canal,     .  .  58 

Alkaline  Bath,     .  .  .40 

Alcoholic  Bath,         .  .  39 

Alvine  Evacuations,        .  .  66 

"  "       Critical,  .  69 

Amaurosis,         .  .  .  229 

"       Causes  of,  .  .  229 

"       Treatment  of,  .  .  230 

Amenorrhoea,    (see  retention  of 

Menses,)  640 
Antacids,  ...  43 
Anthelmintics,     .  .  .43 

Antispasmodics,         .  .  44 

Antispasmodic  Tincture,  .  .  445 

Anthrax,  (see  Carbuncles,)  .  395 
Anasarca,  (see  Dropsy  of  Cellular 

Membrane,)  560 
ApthEe,    .  .  .  .353 

"     Treatment  of,  .  353 

"  Differs  from  Thrush,  .  353 
Apoplexy,      .  .  .  424 

"      Symptoms  of,  .  .  424 

"      Causes  of,  .  .  425 

"      Treatment  of,  .  .  426 

"      Diet  in,      .  .  427 

"      Prophylactic  Treatment 

for,  427 

Armstrong  Dr.,  on  Fever,  .  122 
"  "       Scald  Head,  403 

Arnold  Dr.,  on  Spleen,  249 
Astringents,        .  .  .45 

Asthma,        .  .  •  278 

"     Symptoms  of,     .  .  278 

"     Treatment  of,  .  279 

Ascites,  (see  Dropsy  of  Abdomen,)  526 
Attitude,        .  .  64 

Auscultation,      .  .  .69 


Page. 

B. 

Bath,  Acid,         .  .  .40 

"    Alcoholic,        .  .  39 

"     Alkaline,    .  .  .40 

"    Vapor,  ...  38 


Bartlett,  Dr.,  on  Typhoid  and 

Typhus  Fevers,  119,  122 
Barbour,  Dr.,  on  Congestive 

Fever,  128,  134 


Balby,  Dr.,  on  Yellow  Fever,  .  156 

Baldwin,  Dr.  R.,  on  Scarlatina,  183 

"          "      "  Dysentery,  .  315 

Bird,  Dr.,  on  Cholera,          .  326 

Bladder,  Diseases  of  the,  .  367 

"      Inflammation  of,      .  370 

"             "        Causes  of,  .  371 


"  "        Treatment  of,  372 

"  "        Chronic,     .  373 

"  <  <  "  Treat- 

ment of,  373 
"      Bleeding  from,        .  495 
Bleeding  at  the  Nose,      .  .  475 

"  "         Cause  of,  476 

"  "  Treatment  of,  477 

"  "  Mechanical 

Agency  for,  478 
"  from  the  Lungs,  .  481 
"  "      Causes  of,  484 

"  "       Symptoms  of,  481 

"  "       Treatment  of,  484 

"  «       Diet  for,  490 

"  from  the  Stomach,  .  491 
"  "       Symptoms  of,  491 

"  "       Causes  of,  .  492 

"  "       Treatment  of,  493 

"  "       Diet  for,     .  494 

"  from  the  Bladder,  .  495 
"  "       Diagnosis  of,  496 

"  "       Treatment  of,  497 

Bowels,  Inflamed  condition  of  the 

Membrane  of,  60 
"  Hemorrhage  from,  .  515 
Bowers,  Dr.,  on  Dry  Belly  Ache,  337 
Bono,  Dr.,  on  Yellow  Fever,  .  160 
Boling,  Dr.,  on  Typhoid  and  Ty- 
phus Fevers,  119 
Brain,  Inflammation  of,  (see 

Phrenitis,)   59,  210 
Brandy  Sores,      .  .  .687 

Breath,  Fetid,  .  .  67 

Bronchitis,  Acute,  .  .  261 


714 

Bronchitis,  Acute,  General  Symp- 
toms of, 
"  "     the  pulse  in, 

"  "     State  of  Gene- 

ral surface  in, 
"  "     Progress  of,  . 

"  "     Treatment  of, 

Brown,  Dr.,  on  Deafness, 
Bryan,  Dr.  L.  A.,  on  Intermittent 
Fever, 

"  "  Scarlatina, 

"  "  Erysipelas, 

Buboes,  Treatment  of, 

Buchanan,  Dr.,  on  Htemospasis,  . 

C. 

Calomel,  (its  use  and  abuse,)  . 
Cathartics, 

Cancrum  Oris,  (see  Canker,)  . 

Canker,  .... 
"     Treatment  of, 

Carbuncles, 

"       Treatment  of, 
"       Diet  for, 

Cellular  Tissue,  Diseases  of,  . 
"      Membrane,  Dropsy  of,  . 
"  "     Symptoms  of, 

"  "     Causes  of, 

"  "     Treatment  of, 

"  "     Diet  for, 

"  "     Proper  drinks  in, 

"  "     Bathing  in, 

Cephalalgia,  (see  Headache,) 

Chambers,  Dr.,  on  Rheumatism, 

Chancre,  Varieties  of, 

Chicken  Pock,  (see  Varicella,) 

Chest,  Dropsy  of  the 

"  "       Causes  of,  . 

"  "       Symptoms  of, 

*  "       Treatment  of, 

Cheyne,  Dr.,  on  Hydrocephalus, 

Cholera  Morbus, 

"        "      Causes  of, 
"        "       Symptoms  of, 
"        "      Treatment  of,  . 
"  Asiatic, 

"        "       Pathology  of,  . 
"        "       Treatment  of, 
"        "       the  cold  dash  in, 
"        "       Sulphur  in,  . 
"  Infantum, 
"        "       Symptoms  of, 
"        "       Treatment  of,  . 
"        "       Diet  in, 

Chorea,  (see  St.  Vitus'  Dance,)  . 

Clap,  (see  Gonorrhea,)  . 

Colic,  .... 


INDEX 


"  Flatulent, 
tt  <« 

"  Bilious, 
tt  u 

a  a 


Treatment  of, 

Symptoms  of, 
Treatment  of, 


Page. 

261 
261 

261 
261 

263 
639 

93 
183 
210 
602 
219 


520 
45 
355 
355 
355 
395 
397 
399 
526 
560 
561 
563 
564 
569 
570 
572 
405 
192 
595 
171 
550 
550 
550 
552 
541 
319 
319 
320 
320 
321 
321 
321 
322 
326 
329 
329 
330 
332 
436 
574 
332 
333 
333 
333 
334 
334 


Page. 

Colic,  Painters,         .  .  335 

"  "       Symptoms  of,    .  335 

"  "       Treatment  of,  335 

"    Constipated,  .  .  337 

"    Epidemic,        .  .  346 

"  "  Cure  of  with  Spasms,  346 
Congestive  Fever,  .  .  128 

"    Etiology  of,  .  128 
"  "    Indications  of  seat 

of  Congestions, 
44  "    Symptoms  of, 

"  "    Type  of, 

"  "    Treatment  of,  . 

"  "    Cold  water  in, 

"  "    Regimen  in, 

"  "    Cases  of,  144  to 

Consumption, 


Symptoms  of, 
"  State  of  surface  in, 

"  Treatment  of, 

Constipation,  . 

"         Cause  of, 
"  Treatment  of,  . 

"         Diet  for 
Contagion,     .  .  .81, 

Continued  Fever, 

"  Symptoms  of, 

"  "    Prognosis  of, 

"  «?    Treatment  of, 

"  "    Local  Complica- 

tions of, 

Convulsive  Diseases,  . 
Convulsions, 

"  Symptoms  of, 

"  Diagnosis  of, 

"         Treatment  of,  . 
Countenance,  . 

"     in  simple  Fever, 

M        Inflammation  of  Chest, 

"        dull  pain  in  Chest,  . 

"        Effusion  into  the  Lungs, 

"  Phthiscal, 

"        Chronic  disease  of  the 
Bowels, 

"        Organic   affections  of 
the  Heart, 
"        Soporose  affections, 
"        Syncope,  . 
"  Chlorosis, 
"     Alterations  in  the 
Hippocratic, 


Coughs, 
tt 

Cramp, 


Spasmodic, 


Varieties  of,  . 
"     Symptoms  of, 
"     Duration  of, 
"     Causes  of,  . 
"     Diagnosis  of,  . 
tt     Prognosis  of, 
"     Treatment  of,  . 
Critical  Days, 


129 
130 
130 
130 
137 
143 
148 
284 
284 
284 
284 
306 
306 
306 
309 
158 
114 
114 
116 
116 

118 
405 
441 
442 
444 
445 
54 
54 
54 
54 
54 
55 

55 

55 
55 
55 
55 
64 
64 
59 
59 
447 
448 
448 
449 
449 
450 
451 
451 
68 


INDEX 


15 


Page. 

Critical  HiTpniorrliagGS,  • 

69 

Sfl  Cell,  • 

69 

"     Alvine  Discharges,  . 

69 

Croup,               •  • 

359 

"     Symptoms  of,  . 

359 

"     Varieties  of, 

.  360 

"     Duration  and  cause  of, 

361 

"     Treatment  of, 

.  361 

"     Liable  to  recur, 

362 

Cuticular  Surface, 

59 

Cynanche  Tonsillaris,  (see  Quinsy,)  357 
"  Trachealis,  (see  Croup, )  359 
"      Parotide,  (see  Mumps,)  362 

Cystitis,  (see  Inflammation  of  the 

Bladder,)  370 

D. 

Deafness,       .  .  .636 

"       Causes  of,         .  .  636 

"  Treatment  of,  .  638 
Dengue,   .  .  .  .184 

"     Symptoms  of,  .  184 

"  Prognosis  of,  .  .188 
"     Treatment  of,  .  189 

Dereze,  Dr.,  on  Yellow  Fever,  .  156 
Diaphoretics,  46 
Diagnosis,  General,         .  .  51 

Diabetis,  (see  immoderate  flow  of 

Urine,)  382 

Diarrhoea,      .  .  .  315 

"  Symptoms  of,  .  .316 
"       Treatment  of,       .  316 

Dickson,  Dr.,  on  use  of  water  in 

Fever,  137 

"  "      Dengue,         .  189 

Dimness  of  Sight,  (see  Amaurosis,)  229 
Diseases  not  classified,  .  663 

Diuretics,  .  .  .47 

Douglas,  Dr.,  on  Fever,  .  121 
Dropsy  of  the  Abdomen,  .  .  527 

"         "    Head,    .  .  539 

"         "    Chest,        .  .  550 

"         "    Scrotum,  .  555 

"  "  Cellular  Membrane,  560 
Dry  Belly  Ache,        .  .  337 

Dundas,  Dr.  R.,  on  Fever,  .  120 
Dysentery,  .  .  .310 

"       Symptoms  of,        .  810 
"       Causes  of,       .  .311 
"       Treatment  of,        .  311 
Dysmenorrhcea,  .  .  .  647 

"  Symptoms  of,  647 

"  Causes  of,  .  648 

"         Treatment  of,  648 
Dyspepsia,     .  .  .60,  294 

"       Symptoms  of,  .  .  294 

"       Causes  of,  .  .  294 

"  Tobacco  a  cause  of,  .  295 
"       Treatment  of,       .  300 


Ear,  Diseases  of  the, 


632 


Page. 

Ear,  Inflammation  of  the,  .  632 

"  "  Causes  of,  634 

«  11  Symptoms  of,  634 

"  "         Treatment  of,  635 

Elliotson,  Dr.,  on  Dropsy,  .  531 

"  "      Chorea,      .  440 

«  m      Threnitis,       .  215 

"  M      Pneumonia,  273 

Ellis,  Dr.,  on  Scald  Head,  .  403 

Emenagogues,  .  .  48 

Emetics,  .  .  .  .47 

Emollients,  ...  41 
Eneuresis,    (see    incontinence  of 

Urine,)  380 
Enteritis,  (see  inflammation  of  In- 
testines,) 302 
Epidemics,         .  .  .157 

"      How  to  prevent  them  in 

cities,  157 

"       Winter,      .  .  250 

Epilepsia,  (see  Fits  Epileptic,)  .  415 
Epispastics,  ...  49 
Epistaxis,  (see  bleeding  at  the  nose,)  475 
Erysipelas,     .  .  .  204 

"       Symptoms  of,  .  .  205 

"  Treatment  of,  .  206 
"       Infantile,        .  .  209 

"  "       Treatment  of,  210 

Evacuations,  Alvine,       .  .  66 

Ewing,  Dr.,  on  Anthrax,  .  42 
"  "  Yellow  Fever,  .  164 
"  "  Erysipelas,  .  209 
"        "    Dengue,  .  .  189 

Excretions,  ...  65 
Explanation  of  Terms,    .  .  712 

Eye,  Diseases  of  the  .  .  220 

"  Scrofulous  inflammation  of  the  227 
"  "        "    Symptoms  of,  227 


Fever,  from  Acute  inflammation, 
"     Synochus,  . 
"     in  general, 
"  Symptomatic, 
"     Proximate  cause  of, 
Remote  cause  of, 


56 
60 
76 
76 
76 
76 

Origin  of  all  possible  causes  of,  79 
"  Miasmata  and  Contagion,  81 
"     Intermittent,   .  .  82 

"     Remittent,  .  .  98 

«     Continued,      .  .  114 

"     Typhus  and  Typhoid,  dis- 
tinction between,  123 
*     Congestive,  .  .  128 

"     Yellow,  .  .  154 

"     Eruptive,  .  .  .165 

"     Scarlet,  .  .  175 

' <     Arthritic,  .  .  .190 

"     Sores,  .  .  .687 

Fenner,  Dr.,  on  Fevers,  119,  120 

Fits,  Epileptic,    .  .  .415 

"        "    Symptoms  of,     .  416 


716  IND 

Page. 

Fits,Epileptic,  Frequency  of  attacks,  416 
"  "  Causes  of,  '  .  417 
"        "    Diagnosis  of,  .  418 

"  "  Prognosis  of,  .  418 
"        "    Treatment  of,  .  410 

Flooding,       .  .  .508 

"       Treatment  of,    .  .  509 

"  Mechanical  remedies,  513 
Fluor  Albus,       .  .  .652 

"  Causes  of,  .  652 
"  Symptoms  of,  .  653 
tt  Prognosis  of,  .  654 
"  Treatment  of,  .  655 
"  Macrotin  in,  .  657 
Fundament,  Falling  of  the  .  351 
"  "       Cause  of,  351 

"  "       Treatment  of,  351 

G. 

Gastritis,  Acute,  .          .  .  289 

"    Pulse  in,      .  290 

"          "    Causes  of,  .  291 

"          "    Regimen  in, .  291 

"  "  Treatment  of,  .  291 
"      Chronic,  (see  Dyspepsia,)  293 

Gelseminum,  Sempervirens,  .  151 


"    Generic  Charac- 
ters of,  151 
"    Specific  Charac- 
ters of,  151 
"    Medical  Proper- 
ties of,  151 
"    Dr.  Hickman  on,  153 


Gonorrhea,         .          ,  .574 

"    Supposed  origin  of,  .  574 

"  Local  Symptoms,  .  575 
"    Constitutional  Symptoms,  576 

"    Preventives  of,    .  .  576 

"    Abortive  treatment  for,  578 

"    Treatment  for,    .  .  579 

"    Second  stage  of,       .  581 

"    In  Women,         .  .  584 

"    Recipes  for  cure  of,  .  586 

Gooch,  Dr.,  on  Flooding,  .  511 

Gout,  ....  200 

"    Symptoms  of,        .  .  201 

"    Causes  of,        .          .  201 

"    Treatment  of,        .  .  202 

H. 

Hemorrhages,     .          .  .  475 

"         Critical,          .  69 

"          from  the  Bowels,  .  515 


"  "    Symptoms  of,  516 

"  "    Causes  of,  .  518 

"  "    Treatment  of,  519 

Hemoptysis,  (see  bleeding  at  the 

Lungs,)  481 
Heniatemesis,  (see  bleeding  from 

the  Stomach,)  491 
Hematuria,  (see  bleeding  from  the 

Bladder,)  495 


EX. 


Tage. 

Hemorrhoids,  (see  Piles,)  .  348 

Hand, ....  65 

Hartshorn,  Dr.,  on  Cramp,  .  453 

Heart,  Organic  disease  of,     .  61 

Head,  Dropsy  of  the       .  .  539 

"             "       Causes  of,  540 

"  "  three  stages  of,  542 
"  "  Diagnosis  of,  543 
"             "       Treatment  of,  543 

H             "       Regimen  in,  549 

Headache,          .          .  .  405 

"       Symptomatic,        .  406 

"       Idiopathic,      .  .  406 

"       Treatment  of,        .  409 

Sick,   .          .  .410 
Hepatitis,      .          .  .232 

"     Acute,     .          .  .232 

"         "     Terminations  of,  233 

"     Chronic,  .          .  .234 

"          "     Treatment  of,  235 

"     Suppurative  stage,  .  237 

Helford,  Dr.,  on  Asthma,      .  283 

Hester,  Dr.,  on  Lead  Colic,  .  336 

"          "     Cramp,         .  453 

Herpes,  (see  Tetter,)       .  .  391 

"      Zoster,         .          .  391 

"      Phlyctanodes,     .  .  392 

"      Preputialis,  .          .  392 

"      Cabralis,           .  .  392 

«      Cercinatus,    .          .  392 

"      Labialis,           .  .  394 

Hickman,  Dr.,  on  Gelseminum,  153 

Hillary,  Dr.,  on  Yellow  Fever,  .  156 

Hill,  Dr.,  on  Syphilis,           .  600 

Holland,  Dr.,  on  Kosso,  .  44 

"       "       Consumption,  286 

Homoeopathy,  Liebig  on, .  .  52 

Hopkins,  Dr.,  on  Scarlatina,  .  180 

Hydrarthrus,       .          .  .619 


Hydrocephalus,  (see  Dropsy  of  the 

Head,)  539 

Hydrothorax,  (see  Dropsy  of  Chest, )  550 
Hydrocele,  (see  Dropsy  of  Scrotum,)  555 

I. 

Ice  in  Fever,       .  .  .164 

Inflammations,  .  .  204 

Inflammation  of  the  Brain,        59,  210 
"  "    Abdomen,   .  59 

Intermittent  Fever,    .  .  82 

"  "  Pyrexia,  .  83 

"  "  Cold  stage  of,  83 

"  "  Hot  stage  of,    .  83 

"  "  Sweating  stage  of,  83 

"  "  Incidental  Symp- 

toms, 83 
"  "  Periodical  recur- 

rence, 84 
"  "  Body  only  partial- 

ly affected,  84 
H  "  Alfects  any  period 

of  life,  84 


INDEX. 


717 


Pago. 

Intermittent  Fever,  it  is  liable  to  re- 

o4 

<< 

vuiu  unv/u  nuiia  ui 

O1* 

a 

"  Local  Inflamma- 

tion, 

or 
00 

<< 

^  f^nn  ir^Qf  l  nri  *inrl 

Effusion 

OO 

<« 

"  Enlargement  of 

OO 

(( 

"  Diagnosis  &  Prog- 

nncio  nf 

llUOlo   \Ji , 

ou 

<< 

"  Treatment  of  . 

OO 

it 

ou 

(< 

"  Bleeding  in  cold. 

stage, 

ou 

(< 

"  Treatment  in  hot 

stage, 

87 

n 

"        "  sweat- 

ing stage, 

88 

tt 

"     Prevention  of 

Ague, 

90 

Intestines,  Diseases  of, 

302 

a 

Inflammation  of, 

302 

"  "     Diagnosis  of,  303 

"  "     Treatment  of,  303 

D*ion,  Dr.,  on  Erysipelas,  .  210 
Ischuria  Dysuria,  (see  Suppression 

of  Urine,)  375 
Itch,        .  .  .  .394 

"   Description  of,   .  .  394 

"   Treatment  of,         .  .  395 

J. 

Jaundice,           .          .  .  239 

"       Treatment  of,  .  239 

Jones,  Dr.,  on  Fever,      .  .113 

K. 

King  &  Newton,  on  Intermittent 

Fever,  94 

«  m  "firing,"  197 

King,  Dr.,  on  Fever,  .  .126 
Kidneys,  Diseases  of,  .  .  367 

"     Ditiammation  of,  .  367 

"  "       Symptoms  of,  367 

"  "       Pulse  in,      .  367 

«  "       Treatment  of,  368 

King's  Evil,  (see  Scrofula,)        .  608 

L. 

Lee,  Dr.  Robert,  on  Milk-leg,  .  470 
Leptandrin,    .  .  .238 

Leucorrhcea,  (see  Fluor  Albus,)  .  652 
Litchfield,  Dr.,  on  Scald  Head,  403 
Liver,  Inflammation  of,  (see  Hepa- 
titis, 232 

Lock-jaw,  (see  Cramp,)  .  447 
"       in  Lafants,      .  .  455 

"  "      Causes  of,  455 

"  "       Treatment  of,  457 

Lungs,  Bleeding  from  the     .  481 


Page. 

M. 

Macrotin  in  Fluor  Albus,  .  657 

Maddison,  Dr.,  on  Whooping  Cough,  433 
Mania  a  Potu,  .  .  457 

"         Causes  of,    .  .  457 

"  Symptoms  of,     .  457 

"  Pulse  in,     .  .  457 

"  Treatment  of,    .  458 

McCraven,  Dr.,  on  Synochus  Fever,  60 
"         "        Consumption,  286 
"        "        Yellow  Fever,  163 
"        "       Dengue,    .  184 
Measles,  .  .  .  .171 

"  Contagion  and  Lufection,  171 
"  Sequelae  of,  .  .171 
"    Varieties  of,  .  .  172 

*t  Prognosis  of,  .  .172 
"    Treatment  of,  .  173 

Medicines — their  uses,    .  .  42 

Medical  Correspondence,  .  5 
Melson,  Mr.,  on  Lead  Colic,  .  336 
Meleena,  (see  Haemorrhage  from  the 

Bowels,)  575 
Menorrhagia,  (immoderate  flow  of 

Menses,)  501 
Menses,  Immoderate  flow  of,      .  501 
"  "       Causes  of,  502 

"  "        Symptoms  of,  503 

"  "        Treatment  of,  504 

"     Retention  of,      .  .  640 

"  "       Causes  of,  640 

"  "        Treatment  of,  641 

"     Suppression  of,        .  645 
"     Remote  cause  of,  645 
"  Symptoms  of,  646 

"  "     Treatment  of,  .  646 

Menstruation  Difficult,  (see  Dysme- 

norrhcea,)  647 
Mercury,  (its  use  and  abuse,)     .  520 
Miasmata,      ...  81 
Minnock,  Dr.,  use  of  water  in  Fe- 
ver, 137 

"  "  on  Erysipelas,  .  210 
Milk-leg,       .  .  .469 

"      Causes  of,        .  .  469 

"  Symptoms  of,  .  471 
"       Treatment  of,    .  .  472 

Mortification,  .  .  .697 

Treatment  of,       .  697 
Mouth,  Diseases  of  the,        .  352 
Mumps,   ....  364 
"     Treatment  of,  .  365 

N. 

Narcotics,  .  .  .50 

Nephritis,  (see  Inflammation  of  the 

Kidneys,)  367 
Nervous  System,  Morbid  state  of,  57 
Nettle  Rash,       .  .  .404 

"  "  Treatment  of,  .  405 
Neuralgia,  .  .  .411 

"      Symptoms  of,       .  411 


18 


INDEX 


Page. 

Neuralgia,  Causes  of,       .  .412 
"       Treatment  of,        .  412 
Newton,  Prof.  R.  S.,  on  Cholera,  328 
"  "    Deafness,  639 

"      Dr.,  on  Ulcers,  .  .  675 

Nigan,  Dr.,  on  Scald  Head,  .  402 
Nose,  Bleeding  at  the,     .  .  475 


Old  Sore  legs, 


0. 

Treatment  of, 
Bandage  in, 


687 


689 

Ophthalmia,        .  .  .220 

"       Simple  Conjunctivitis,  221 

"       Treatment  of,  .          .  222 

Chronic,     .          .  225 

"           "       Treatment  of,  225 

"       Catarrhal  &  Purulent,  226 

"             "     Treatment  of,  227 

Scrofulous,           .  228 

"       Gonorrheal,     .          .  229 

Organs  of  reproduction,  Diseases  of,  640 

O'Shaughnessy,  Dr.,  on  Cholera,  327 

Otitis,  (see  inflammation  of  the  Ear, )  632 

P. 

Pain,       .  .  .  .58 

"   Inflammatory,   .  .  58 

"   Spasmodic,  .  .  .58 

"   Neuralgic,         .  .  58 

"   Facts  in  regard  to,  .  .  61 

Palsy,  .  .  .460 

"     Varieties  of,         .  .  461 

"     Symptoms  of,  .  .  461 

"     Diagnosis  of,        .  .  463 

"     Paraplegia,      .  .  464 

"     Treatment  for,      .  .  464 

"     The  douche  in,  .  467 

"     Diet  for,    .  .  .469 

Paracentesis,  .  .  .  536,  554 

Paracusis,  (see  Deafness,)  .  636 
Paralysis,  (see  Palsy,)    .  .  460 

Parker,  Dr.,  on  Pneumonia,  .  276 
"  "    Dengue,  .  .  189 

Parkes,  Dr.,  on  Cholera,  .  321 
Patent  Medicines,  recommended  by 

ministers,  149 
Perspiration,       .  .  .66 

Percussion,  ...  69 
Pertussis,  (see  Whooping  Cough,)  429 
Phlegmasia  Dolens,  (see  Milk-leg,)  469 
Phrenitis,  .  .  .210 

"  Diagnosis  of,  .  211 
"  Causes  of,  .  .215 
"  Prognosis  of,  .  216 
"  Treatment  of,  .  .216 
Phthisis  Pulmonalis,  (see  Consump- 
tion,) 284 

Piles,  ....  348 
"    Cause  of,    .  .  .  348 

"    Treatment  of,    .  .  348 

Pleuritis,  Acute,  .  .  .  254 


Page. 

Pleuritis,  Acute,  General  Symptoms 

of,  254 

"  "  Treatment  of,  256 
Pneumonia,         .  .  .  266 

"  Character  of  Sputa,  267 
"  First  Stage,  .  269 
•<        Second    "    .  .  269 

Third      "  .  269 

"        Fourth    "    .  .  269 

"  Prognosis  of,  .  269 
"        Causes  of,     .  .  270 

"  Treatment  of,  .  271 
"  Ipecacuanha  in,  .  272 
"  Quinine  in,  .  276 
"  Bleeding  in,  .  273 
"        Typhoid,       .  .  277 

"  "      Treatment  of,  278 

Position,  Phthisical,        .  .  56 

"  in  Hydrothorax,  .  56 
"         Inflammation  &  Acute 

pain,  56 

"         Spasmodic  pains,     .  56 
Pox,  (see  Syphilis,)   .         .  589 
Preface,  ....  9 
"     General,       .  .  27 

Pregnancy,  (mistaken  for  Dropsy,)  529 
Prioleau,  Prof.  T.,  on  Dengue,  186 
"     Dr.  P.  G.,         "         .  186 
Prognosis,  General,    .  .  63 

Prolapsus,  Ani,  (see  falling  of  the 

Fundament,)  351 
"       Uteri,  (see  falling  of  the 

Womb,)  660 

Pulse,      .  .  .  .71 

"  Mode  of  examining,  .  72 
"  Pathological  condition  of,  .  73 
"    Frequent,         .  .  73 

"    Slow,         .  .  .73 

"    Quickness  of,    .  .  73 

"    Strong,      .  .  .73 

"  Feeble,  ...  74 
"    Very  soft,  .  .  .74 

"  Full,  ...  74 
*    Swell,        .  .  .74 

"    Depressed,       .  .  74 

"  Intermittent,  .  .75 
"    Unequal,         .  .  75 

"    Undulating,  .  .  75 

"  Morbidly  natural,  .  75 
"    Shattered,  .  .  .75 

"    Obstructed,      .  .  75 

"    Compound,  .  .  75 


Quinsey, 


Q. 

Treatment  of, 


R. 


Rachitis,  (see  Rickets,) 
Respiratory  Organs, 

"  Wheezing, 
Remittent  Fever,  . 


356 
357 


626 
58 
58 


IND 


EX. 


Page. 

Remittent  Fever,  Symptoms  of,  98 
"  "    Remote  cause  of,  98 

M  "    Etiology  of,  .  98 

"  "    Dr.  Rogers  on,  102, 112 

"  "    Hepatic  modifica- 

tions, 102 
n  "  General  indications 

of  cure, 


Rheumatism, 


102 
190 
190 
191 
193 
193 
193 


Rickets, 


Symptoms  of, 
Treatment  of, 
Arnica  in, 
Chronic, 

"  Treatment  of, 
"  Cold  Bathing  in,  196 
"  "  Firing"  in,  197 
"  New  French  re- 
cipe for,  200 
626 
.  626 
628 
.  629 
392 
.  279 
265 


"     Symptoms  of, 
"     Causes  of, 
"     Treatment  of, 
Ringworm, 

Rolison,  Dr.  G.,  on  Asthma, 
Rogers,  Dr.,  on  Bronchitis,  . 
"  "    Use  of  water  in 

Congestive  Fever, 
"  "  Scarlatina, 

"  "  Mortification, 

Rubeola,  (see  Measles,) 
Rush,  Dr.,  on  Yellow  Fever, 
"  "  Dengue, 

S. 

Scabies  Psora,  (see  Itch,) 
Scalp,  Rheumatism  of, 
Scald  Head, 

"       "    Treatment  of, 
"       "    Donevan's  remedy  for, 
Scalds  and  Burns, 

"  "     Four  degrees  of, 

"  "     Effects  in  various 

ages, 

"  "     Treatment  of,  . 

Scarlatina, 

"  Simplex, 
"  Anginosa, 
"  Maligna, 
"        Faucium,  . 
Scarlet  Fever, 

"        (t    Symptoms  of, 
"         "    the  Tongue  in, 
"        "    Causes  of, 
"        "    Prognosis  of, 
"        «    Treatment  of, 
"        "    Throat  and  Head  in 
«         "    Stimuli  in, 
"         "    Prophylactics  in, 
Scorbutus,  (see  Scurvy,) 
Scrofulous  Diseases, 
Scrofula, 
\ 1  Physical  formation  of  Patients, 


138 
182 
697 
171 
156 
189 


394 
407 
400 
401 
404 
697 
698 

699 
700 
175 
178 
178 
178 
178 
175 
176 
177 
178 
178 
179 
180 
181 
181 
663 
608 
608 
609 


Pajre. 
612 
613 
614 
618 
555 
556 


Scrofula,  Symptoms  of,  . 
"      Diagnosis  of, 
"      Treatment  of,  . 
"      Regimen  for, 
Scrotum,  Dropsy  of, 

"  "         Symptoms  of, 

"  "  Treatment  of,  557 
Scurvy,    .          .          .  .663 

"    Causes  of,      .          .  664 

"    Treatment  of,      .          .  665 

"  Condition  of  blood  in,  667 
Sedatives,           .          .  .50 

Sensation,  Morbid,     ,          .  60 

Serous  Tissue,  Diseases  of,        .  526 

Silphium  perfoliatum,           .  250 

Singultus,  (see  Hiccough,)         .  435 

Skin,  Diseases  of,      .          .  391 

Sleep,  Disturbed,           .          .  57 

Small  Pox,     .          .          .  165 
"      «    Premonitory  symptoms 

of,  166 

"      "    Confluent,      .          .  167 
"      "         "    attendant  symp- 
toms of,  167 
"      "    Treatment  of,       .  167 
"      "    New  treatment  for,    .  169 
"      "    To  prevent  pitting,  168 
Smith,  Dr.  A.,  on  Yellow  Fever,  .  122 
Colic,        .  337 
Southmond,  Dr.,  on  Fever,         .  122 
Spleen,  Enlargement  of,        .  85,  242 
"     Diseases  of,        .          .  241 
"     Induration  and  softening  of,  243 
"     Congestion  of,     .          .  243 
"     Treatment  of,            .  243 
Splenitis,  (see  Spleen,)    .  .241 
Sprains,         .           .          .  671 
"     Treatment  of,     .  .671 
Sputa,           ...  59 
Stedman,  Dr.,  on  Dengue,          .  185 
Stewardson,  Dr.,  on  Pneumonia,  273 
Stimulants,  General,       .          .  50 
Stomach,  Diseases  of,           .  289 
"      Bleeding  from,            .  491 
St.  Vitus'  Dance,       .          .  436 
"          "     Symptoms  of,   .  436 
"          "     Nature  of,   .  437 
"          "     Treatment  of,   .  438 
Sweat,  Critical,         .          .  69 
Swine  Pock,  (see  Varicella,)       .  171 
Synochus  Fever,        .          .  60 
Syphilis,  .          .          .  .589 
"       Causes  of,    .          .  589 
"       Primary,          .          .  591 
"       Secondary,  .          .  592 
"       Treatment  of,    .          .  596 
"       Various  Recipes  for,  605 


Table  of  Contents,         .  .  28 

Taenia  Solium,  (see  Worms,)  .  704 
Tapping,  .  .  .  .536 


720 


INDEX. 


Page. 

Taylor,  Dr.,  on  Scald  Head,  .  404 
Tetanus,  (see  Cramp,)     .  .  447 

Tetters,         .  .  .391 

"     Treatment  of,      .  .  393 

Thompson,  Dr.,  on  Asthma,  .  282 
Thoracic  Effusion,  .  .  56 

Throat,  Diseases  of  the  .  352 
Thrush,    .  .  .  .352 

"     Prognosis  of,  .  .  352 

"     Treatment  of,      .  .  352 

Tinea  Capitis,  (see  Scald  Head,)  400 
Tonics,     .  .  .  .51 

Tongue,  white  &  slightly  loaded,  57 
"      pale  and  tumid, .  .  57 

"  contracted  and  pointed,  57 
"  yellow  and  bitter,  .  57 
"      florid  papillae,  .  57 

"      white  or  brown,  .  .  57 

"  indicative  of  disease,  67 
Tobacco,  a  cause  of  Dyspepsia,  .  295 
"  "  "  Diabetis,  386 
Tricocephalus  Dispar,  (see  Worms,)  704 
Trismus  Nascentium,  (see  Lock- 
jaw in  infants,)  455 
Tucker,  Dr.,  on  Dysentery,  .  315 
Typhus  Fever,  .  .  123 

Typhoid    "        .  .  .123 

U. 

Ulcers,  .... 
Healthy, 

"     Treatment  of, 
Irritable, 

"      Treatment  of, 
"     Cases  of, 
"     Sulphate  of  Zinc  in, 
Indolent, 

"     Treatment  of, 
Varicose, 

"     Treatment  of 
Chronic, 


V. 


Page. 


Urine,      ...  59 

"  Bilious, 

"  Excess  of,  . 

"  Suppression  of, 
"  "         Treatment  of, 

"  Retention  of, 
"  "         Causes  of, 


672 
673 
673 
674 
074 
677 
677 
681 
682 
685 
685 
687 
,  62 
59 
69 
375 
376 
377 
377 


"  "         Treatment  of,  378 

"  Incontinency  of,  .  380 
"  "         Treatment  of,  381 

"  "  Varieties  of,  382 

"  Immoderate  flow  of,  .  382 
"  "  Treatment  of,    .  383 

"  "  "  .  388 

"  tl  Termination  of,  385 

"  "  Tobacco  conducive  to,  386 

Urticaria,  (see  Nettle  Rash,)  .  404 
Uterus,  Bleeding  from,    .  .  501 

Uterine  Heeinorrhage,  .  508 


Variola,  Confluent,  (see  Small  Pox,)  16"; 


170 
574 

165 
548 
66 
299 
299 
300 


Varicella, 
Venereal  Diseases, 
Verbena  Jamaicensis, 
Vere,  Dr.,  on  Hydrocephalus, 
Vomiting, 

"     Causes  of,  . 
"     Treatment  of,  . 

W. 

Wakefulness,       .  .  .60 

Waller,  Dr.,  on  Scarlatina,  .  180 
Waring,  Dr.,  on  Dengue,  .  184 

Watson,  Dr.,  on  Gout,  .  202 

"  "    Hydrocephalus,  548 

Winter  Epidemics,     .  .  250 

White  Swelling,  .  .  .619 

"  Rheumatic,  .  619 
"  "    Treatment  of,  620 

"  Scrofulous  or  True,  622 
Symptoms  of,  622 
Treatment  of,  625 
652 
429 
429 
429 
126 
501 
660 
661 
662 
704 
704 
704 
704 
704 
704 
704 
705 


Whites,  (see  Fluor  Albus,) 
Whooping  Cough, 

"  "     Symptoms  of, 

"     Treatment  of, 
Wilbur,  Dr.,  on  Fever, 
Womb,  Bleeding  from, 
"     Falling  of  the 

Causes  of, 


Worms, 


Treatment  of, 


Round, 
Thread,  . 
Long  Thread, 
Common  Tape, 
Broad  Tape,  . 
Symptoms  of, 
Treatment  of. 


Xanthoxylon  Fraxineum, 


328 


Y. 

Yandall,  Dr.  L.  P.,  on  Remittent 

Fever,  100 

Yeats,  Dr.,  on  Hydrocephalus,  .  541 
Yellow  Fever,  .  .  154 

"        "    the  producing  circum- 
stances of,  155 
"        "    Exposure,  fatigue  and 
excesses  conducive 

to,  156 

"  "  Treatment  of,  .  161 
"        "    Ice  in,    .  .  161 

"        "    Newly  married  per- 
sons victims  to,  156 


\ 


■ 


I 

Massie 
1853 


